European Journal of Cardiovascular Medicine

Background: Obesity is a complex, multi-factorial, chronic condition that is associated with mortality and significant morbidity and is prevalent worldwide. The prevalence of obesity is increasing to very rapid proportions at an alarming rate in both developed and under developed countries around the world. An increase in the prevalence of obesity in young adults has been seen around the world. Body mass index (BMI; in kg/m2) is widely used for the classification of overweight (BMI 25-30 kg/m2) and obesity (BMI > 30 kg/m2) in men and women. BMI correlates reasonably well with laboratory-based measures of adiposity, and is extremely practical in most clinical settings for population studies. Multiple measures of adiposity showed a significant inverse relationship with both static lung volumes and spirometry. In adults, pulmonary function abnormalities are well reported complications of obesity; the most frequently reported abnormalities are decrease in lung volumes and expiratory flow rates. The aim of the study is to determine the effect of obesity on pulmonary function abnormality in young adults in our population. Materials and methods: A cross sectional study was conducted at Department of Anesthesia & ICU and Health sciences center Kuwait over a period of 1 year. A total of 20 normal, 20 overweight and 20 obese participants, aged between 18 to 40 years were included in the study. BMI was calculated by measuring weight and height by BMI scale (RGZ-160) in standing position. Pulmonary parameters were determined by spirometry onPower lab. Pulmonary parameters were compared between subjects in different categories of BMI. Result: Age, height, weight & BMI were significantly different among overweight, obese and normal weight group. The mean age of overweight, obese and normal subjects was 17.07±4.35, 33.08±0.99, and 17.07±2.28 years with a range from 18-25 years. The mean height of overweight, obese and normal weight group was 167.19±7.25, 166.5±6.49 and 174.7±8.08 cm respectively. The mean weight of overweight, obese and normal group was 74.8±7.45, 85.8±6.44 and 64.7±9.75 kg respectively. The mean BMI of overweight, obese and normal weight group was 28.59±2.35, 33.08±0.99 and 23.85±2.64 kg/m2 respectively. The observed values of various lung function parameters are provided in Table-2. In overweight & obese groups FVC, FEV1 and PEFR were decreased significantly (P<0.05). FEV1/FVC ratio was not significant in overweight, obese and normal weight subject as p > 0.05. Conclusion: Obesity influences the respiratory function enhancing dyspnoea and increasing both cardiac load and respiratory muscle fatigue of the thoracic wall and the diaphragm due to the higher pressure exerted by intrabdominal adipose accumulation. In our study the results showed that increase in BMI had an inverse relationship with FVC, FEV1 and PEFR in obese when compared to the normal weight subjects.

Objective- To describe the association of Systolic Blood Pressure with outcomes in children with acute non traumatic neurological illnesses. Materials and Methods- the present prospective observational Study conducted in the PICU, Department of Pediatrics of central India over the period of 1 year 6 months, All patients admitted with acute non traumatic neurological illnesses. Children between the age group of 1-14 years of age, admitted with the provisional diagnosis of acute neurological illnesses -acute encephalitis syndrome, pediatric stroke, meningitis, hepatic encephalopathy and seizure were included while all cases of acute traumatic neurological illnesses and/or Patients with chronic illnesses of any system were excluded. Results- the study was conducted among 249 subjects, out of which 57.4% (n=143) belonged to the age group of 1-5 years, 30.9% (n=77) subjects were of 5-10 years, 11.6% (n=29) subjects were of more than 10 years of age. Out of which males 63.1% (n=157) were male and 36.9% (n=92) subjects were female. Among all subjects 50.6 % (n=126) had primary diagnosis of seizure disorder, 41.4% (103) had acute encephalitis syndrome, 5.2% (n=13) had bacterial meningitis. which death rate was reported in 11.2% . In present study systolic blood pressure was found to be a significant predictor of mortality across the time points. Across the time points death was more common in those with systolic blood pressure. Conclusion- Children with acute non-traumatic neurological illnesses have higher systolic blood pressure in the Pediatric Intensive Care Unit (PICU), which increases mortality and hospital stays. The relationship between systolic blood pressure and acute non-traumatic neurological illness in children needs further multi-institutional research. Timely and proactive blood pressure treatment improves mortality and hospitalization rates.

Background- Severe Acute Malnutrition is a major problem in developing countries. According to UNICEF, India's infant mortality rate in 2020 was 29.07 per 1000 live births, while the under-5 death rate was 32.6 per 1000 live birth.UNICEF emphasis malnutrition runs in family and affected by certain factors such as socioeconomic factors, dietary factors, anganwadi visits, age of starting of complementary feedingetc and causes malnutrition in siblings of SAM and MAM children. Objective of the study is to find out Nutritional and immunization status off siblings of SAM and MAM children and to find out the factors responsible for that. Methodology -This is observational cross sectional study, total 150 siblings of Severe and Moderate Acute Malnutrition children age group of 6 months to 60 months with fulfillment of inclusion and exclusion criteria .detailed history is taken on immunization status and on dietary status .examination done on anthropometry and other system. Data filled in proforma and compared with standard charts. Results- It is observed that among 150 subjects 13.3% were SAM 16.0 %were MAM and 70.7% were normally nourished. And 84% were fully immunized as per national immunization schedule and rest was partially immunized.And certain factors play important role such as inadequate calorie intake (p<0.001), aanganwadi visits (p<0.001) age of starting of complementary feeding (p<0.012). Conclusion-The study concludes that siblings of SAM and MAM patients should be examined for anthropometry and screened.

Background- Thalassaemia is a chronic condition that necessitates long-term treatment in a significant proportion of individuals. Despite recent advancements in medical care, there is a lack of effort to enhance the psychological well-being of these individuals. The objective of this study is to provide a comprehensive description of the psychological morbidity experienced by individuals diagnosed with transfusion dependent β-thalassaemia. Methods- The current study was undertaken as an observational, cross-sectional study within the Pediatrics department of a tertiary care teaching institution situated in central India. The study was conducted over a period of one year. The study recruited participants who met the following criteria: they were children aged 2 to 18 years, diagnosed with transfusion-dependent β thalassemia major, and receiving regular blood transfusions at the department. Total 95 children were included in the study.  Results- A total of 95 children (47 boys and 48 girls) with transfusion-dependent thalassemia with a mean age of 8.83 ± 2.70 years were included in this study. 58.69% of the population were belonging to nuclear families. Patients came from all the socio-economic strata of society but the lower class was dominant. the prevalence of abnormal scores in emotional, conduct, and hyperactivity symptoms among children diagnosed with TDBT. Specifically, 18% of children exhibited abnormal emotional symptom scores, 17% displayed abnormal conduct symptom scores, and 9% shown abnormal hyperactivity symptom scores. Conclusion- The findings of our study indicate that children diagnosed with transfusion-dependent thalassemia major experience a significant burden. Additionally, these children experienced a range of psycho-social disorders. As a result of their persistent medical condition, they exhibit a mild decline in overall functioning. The significance of providing comprehensive care and suitable psychological intervention for children with thalassemia is underscored by our study.

Background:  Diabetes mellitus (DM) is a chronic metabolic disorder characterized by persistent hyperglycemia. It may be due to impaired insulin secretion, resistance to peripheral actions of insulin, or both. According to the International Diabetes Federation (IDF), approximately 415 million adults between the ages of 20 to 79 years had diabetes mellitus in 2015. [1] DM is proving to be a global public health burden as this number is expected to rise to another 200 million by 2040. This is a Prospective, Cross sectional, Randomization, Observational study wa conducted in the Department of Biochemistry and Medicine, Index Medical College. Inclusion Criteria: Controls without family history of type 2 diabetes: Healthy subjects in the age group of 18 - 30 years of either Gender. Exclusion Criteria: Individuals who are using any medicines for any health condition to restrict in performing sub-maximal exercise. TAOS while comparing between control group (without family history of type 2 diabetes) and case group (with family history of type 2 diabetes), in our study found that in mean and standard deviation of TAOS in 18- 21 years in control group (1.45 + 0 .34 mM) and case group (0.71 + 0.46 mM) was statistically not significant difference between both groups (p=0.061), meanwhile TAOS in 22- 25 years in control group (1.37 + 0 .47 mM) and case group (0.45 + 0.14 mM) was statistically significant difference between both groups (p=0.003). MDA in 18-21 years in Case Group showed an increase in Mean 11.05 + 9.26 mM then control group 6.14 + 0.89m M (p<0.0001), MDA in 22-25 years in Case Group showed an increase in Mean 13.05 + 9.34 mM then control group 5.74 + 1.19m M.

Background- Acute kidney injury (AKI) is common after cardiac surgery. To date, there are no specific pharmacological therapies. In this review, we summarise the existing evidence for prevention and management of cardiac surgery-associated AKI and outline areas for future research. Preoperatively, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers should be withheld and nephrotoxins should be avoided to reduce the risk. Methods- The present study is an observational study was conducted at tertiary care center on all the patients undergoing on pump CABG during the study period of 18 months i.e. from 1st January 2020 to 30th June 2021. Adult patients belonging to 41 to 70 years of age, of Either gender, Diagnosed with triple vessel, double vessel or even single vessel disease, Scheduled for on-pump CABG surgery and Belonging to the American Society of Anaesthesiologist (ASA) –II and III physical status were included.  Results- The average age of patients undergoing cardiac surgeries in India is 60 years. ] In present study, majority of patients undergoing on-pump CABG belonged to elderly age group (>60years) and more than 75% cases were males. CABG can be done as both off pump and on pump procedure. On pump CABG is the procedure of choice in presence of CPB. Literature sugeste CPB is an important factor associated with AKI. Chloride liberal fluids were used in our study in patients while undergoing on pump CABP. Both ringer lactate and normal saline were the chloride liberal fluids used in almost all the cases (>95%) irrespective of presence or absence of AKI. PRBC and cryoprecipitate were required in majority of patients whereas FFP and SDP were required in only few cases. In present study, we documented no significant association of AKI with the blood products used (p>0.05). Mean systolic blood pressure preoperatively was 127.53±10.32 whereas that postoperatively was 113.47 ± 9.75 mmHg. Similarly, mean diastolic blood pressure before and after the procedure was 72.53±12.53 mmHg and 58.97 ±7.52 mmHg respectively. We documented no significant difference in mean SBP as well as DBP in patients with or without AKI (p>0.05). Conclusions- Based on this study, peri-operative AKI is high in pump CABG patients receiving chloride liberal fluids like normal saline and/or ringer lactate. Chloride liberal fluids in on-pump CABG predict AKI, but age, gender, comorbidities, amount of fluids, duration of CPB & CABG, transfusion of blood & blood products, and systolic & diastolic blood pressure did not. Our study participants had higher AKI rates, but this did not affect adverse outcomes or mortality.

Introduction: Early detection and treatment of dysglycemia including diabetes and pre- diabetes is demonstrated to improve disease outcomes and prevent complications. Material and Methods: This is a Prospective observational cohort study, A total of 240 patients from Outpatient department (OPD) and Indoor patient (IPD) department of Medicine, Dr. Baba Saheb Ambedkar Medical college and Hospital, New Delh. Anthropomorphic measurements, demographic and clinical information were taken, and blood pressure was measured. Fasting blood sample was obtained for the measurement of plasma glucose (FPG), glycated hemoglobin (HbA1C), and lipid profile. Plasma glucose was estimated 1 hr after the ingestion of 50 g glucose (1h-OGTT). Prediabetes and dyslipidemia were defined according to international guidelines.  Results: A total of 240 individuals were included with a mean age (±SD) of 53.020+-16.5 years, mean BMI of 24.555±12.8 kg/m2. The initial lipid parameters of the participants were analyzed. It was found that 77% of the individuals had baseline total cholesterol levels within the normal range, with a mean value of 170.8mg/dl. Additionally, 85% of the participants had baseline HDL levels within the normal range, with a mean value of 41.9mg/dl. At baseline, 50% of the participants had normal LDL levels, while the other 50% had abnormal LDL levels, with a mean value of 100.6mg/dl. Furthermore, 94% of the participants had baseline VLDL levels, with a mean value of 22.2mg/dl. Lastly, 89.5% of the participants had baseline TG levels within the normal range, with a mean value of 100.75mg/dl. Conclusion: Even though high LDL-C is associated with prediabetes, a recommendation for universal screening of prediabetes patients requires further cohort studies.

Background: Diabetes mellitus is the most common endocrine disorder. It is a state of persistent hyperglycemia secondary to defects in insulin secretion, insulin action, or both. The development of Diabetes involves several pathogenic processes ranging from autoimmune destruction of the β cells of the pancreas resulting in absolute insulin deficiency, to other abnormalities that result in insulin resistance. The purpose of this study helps in recognition of the interdependent relationship between thyroid disease and diabetes and guides clinicians on the optimal management of both these conditions. Methods: This is a hospital based prospective study of 100 patients with type 2 diabetes mellitus admitted in the Department of General Medicine, SVRR Govt. General Hospital S.V.Medical college, Tirupati. Fasting and postprandial blood sugars HbA1C thyroid profile which includes t3, t4, TSH levels were measured. Results: Out of 100 patients, 77.0% of patients had normal thyroid function (i.e. Euthyroid). 16.0% of patients had subclinical hypothyroidism. 6.0% of patients had Hypothyroidism and 1% of patients had Hyperthyroidism. The mean ofHbA1C (1%) in patients with thyroid dysfunction was 9.00 (i.e. 1.74). The mean(SD) of HbA1C(1%) in patients with normal thyroid function was 8.78 (i.e. 1.52). This was statistically insignificant (P value 0.441). Conclusion: There was no significant difference between Euthyroid patients and patients with thyroid dysfunction in terms of duration of Diabetes and HbA1Cin the present study.

Background: Sepsis, a potentially fatal medical condition, typically prompts patients to seek initial medical attention in the emergency department (ED). However, the timely detection of sepsis in this setting is often difficult due to the absence of a reliable diagnostic framework. Methods: The current study pertains to a case-control study involving adult patients who have been admitted to an intensive care unit. The study included individuals who were admitted to the hospital with sepsis as the primary cause and had previously undergone a complete blood count examination. These individuals were classified as case patients.  Results: The identification of risk factors for sepsis includes a neutrophil-lymphocyte ratio exceeding 5.0, leukocyte count surpassing 12,000mm3/mL, and band neutrophil percentage exceeding 10%. Nevertheless, it is worth noting that only the SAPS 3 and SOFA score demonstrated a significant association with patient mortality. Conclusion: The neutrophil- lymphocyte ratio and band neutrophils in combination with other parameters may be markers for the early detection of sepsis in intensive care units.

Background: The goal of the study is to determine how frequently patients with cholelithiasis/ choledhocolithiasis also have hypothyroidism. To determine whether a thyroid profile is necessary for biliary lithiasis patients. Method: A prospective and observational investigation carried out at the Department of General Surgery, Sri Venkateswaraa Medical College Hospital & Research Centre, Puducherry, India ethics committee granted permission for a study to be conducted on 75 subjects from April 2022 to March 2023. Result: The average age of gallstone sufferers is 47.14 years old. The ratio of men to women is 1: 2.2. Hypertension was the most common co-morbidity, affecting 21.3% of the patients. Four patients were converted from a laparoscopic to an open operation out of the 35 patients who received laparoscopic cholecystectomy. Hypothyroidism was present in 27% of patients with cholelithiasis/choledocolitiasis. The majority of the group was female and aged between 50 and 70. This category includes more than 72% of hypothyroidism patients. Conclusion: The study found that middle-aged females are at greater risk for hypothyroidism. Undiagnosed and untreated hypothyroidism in such persons will cause recurrence and consequences. Thus, early treatment of hypothyroidism-related gall stones will help patients.

Context: A significant proportion of survivors from COVID-19 infection have shown residual pulmonary abnormalities including lung fibrosis which if not managed at appropriate time can cause disastrous effects, even requiring lung transplantation in few patients.  Aims: To evaluate the usefulness of Mean CT Severity Score of initial scans done during acute illness in predicting Post-COVID Syndrome. Settings and Design:  A prospective observational study was conducted in a tertiary care centre comprising of 2000 patients, among which 650 patients showed residual lung abnormalities. Methods and Material: HRCT Scan was performed to calculate Mean CT Severity Score during acute illness and after an interval period of 1 month, 3 months and 6 months respectively to detect residual lung abnormalities. Statistical analysis used: SPSS software used for calculation of mean and standard deviation. A chi-square test was used for the comparison of categorical variables. (P-value <0.05, significant) Results- At cut off score of 7 of Mean CT Severity Score calculated at initial scan, high sensitivity and specificity of Mean CT Severity Score was found in predicting Post Covid Syndrome. Moreover, the study found significant association between the lesions including ground-glass opacities, reticular opacities and consolidation separately with high initial CTSS score with their persistence in post COVID follow up scan. (P value- <0.001) Conclusion – Mean CT Severity Score can act as an effective parameter in predicting long term pulmonary outcome of COVID-19 illness and can guide towards appropriate management of the patient’s allowing intervention at an early stage in post-COVID syndrome.

Background: Improvement of number of low birth weight (LBW) baby-mother dyad practicing KMC in postnatal ward in a tertiary care hospital of eastern India and to increase number of babies weighing between 1.8-2.5kg receiving KMC from 11.5% to at least 60% in postnatal ward with increment of total duration from 1.9 to minimum 8hours a day. Methods: QI team was formed. The potential barriers for initiation of KMC among this group of dyads were evaluated using fish bone analysis. Stepwise measures (initiation of early skin-to-skin contact immediately after birth), KMC as an integral part of treatment, counseling of mothers, allotting dedicated nursing staff in each shift to monitor KMC, introduction of bedside KMC Sheet with KMC register, provision of separate beds for “KMC corner”) were introduced and subsequently tested by multiple Plan-do-study-act (PDSA) cycles. Data on duration of KMC per day was measured by bedside nurses on daily basis. Results: Total 510 neonates were enrolled in the study (110 in baseline phase, 116 in implementation phase and 293 in post intervention phase). Demographic characteristics including birth weight and gestational age were comparable among baseline and post intervention cohorts. During implementation phase, KMC of any duration was received by 40.5%, 67%, 82.5% and 95% neonates following PDSA I, PDSA 2, PDSA 3 and PDSA 4, respectively against 11.5% of baseline phase. In comparison to baseline phase, mean duration of KMC increased from 1.9 hours to 8.6 hours during post implementation phase. Conclusions: Stepwise implementation of PDSA cycles significantly increased the percentage of LBW newborns of weight 1.8-2.5kg receiving KMC for >6 hours a day in Postnatal Ward, thereby resulting in earlier discharge.

Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder categorized by abnormalities in social interaction, impairment in language and communication, restrictive or repetitive interests, and stereotyped behaviors and movements. It seems more likely that asthma and ASD could arise from common or related pathologic disruptions of the immune system. as in India, no study has been done on this topic,so we chose this topic . Aim: To compare the prevalence of bronchial Asthmain children having Autism spectrum disorder with children not having Autism spectrum disorder. Methods: this observational and cross-sectional study was conducted on 50 children,who had autism spectrum disorder in the age group of 3-17years, who were attended OPD of Psychiatry and Pediatric Department Of Rajindra Hospital Patiala over one and half year duration.50 age and sex matched children who were attended OPD for minor illness and had not any psychiatric illness, were taken as a control group. Parameters like age, sex, geographical distribution and socioeconomic status were assessed. Diagnosis of autism spectrum disorder was confirmed by using INCLEN diagnostic tool (ANNEXURE). Children having autism spectrum disorder were further evaluated for presence or absence of Asthma.  Results: it was observed that the mean age of ASD cases is 9.47 ± 4.07 years and 6.6 ± 3.87 years for ASD with concomitant Bronchial Asthma. There were more no. of patients of ASD belonged to younger age group (up to 8years), male gender (68.5%) and middle-class population. There was more no. of cases of ASD with concomitant bronchial asthma from young age group (up to 8 years), male sex (81.5%)and urban area as compared to control group (nonASD with bronchial asthma). It was observed that in our study prevalence of bronchial asthma in ASD cases is 22%, and in non ASD control group is 16%.however, this was statistically nonsignificant. Conclusion: No association could be found between Bronchial Asthma and ASD.

Diagnosis of extrapulmonary tuberculosis is challenging due to pauci bacillary disease and is mostly multidimensional involving judgmental assessment of clinical features and disease-related structural radiological changes. The study was undertaken to assess the utility of CBNAAT in field conditions in evaluatingboth Pulmonary and extrapulmonary tuberculosis patients. Methodology: This study was a prospective Observational study conducted in a tertiary care hospital in Jamnagar, West Gujarat. Among 125 extra-pulmonary patients, 34.4% were 20-39 years and 68(54.4) were males, and 85(68) were newly diagnosed. In pulmonary 36.9% were 20-39 Years,51(78.4) were males and 45(69) were newly diagnosed. Results: Out of 125 extrapulmonary TB patients, CBNAAT detected MTB in 50%,44.44%,34.71%,15%,10%,10%,0.0%,and0.0% respectively in articular, pus, lymph node, CSF, pleuralfluids, gastric fluids, pericardialand urinary TB. CBNAATMTB detection was 66.67%, 50% ,50%,0.0%,33.33%, and 0.0%in pus aspirated from psoasabscess, breastabscess ,chest walls welling, splenic abscess, gluteal abscess, and occipitals welling respectively. Conclusion: The diagnostic efficacy of CBNAAT MTB was greater in pulmonary TB than in extrapulmonary TB. The highest diagnostic yield of CBNAAT was found in non-lymph nodalpurulentaspirate, most forpsoas abscessaspirate. The lowest diagnostic efficacy of CBNAAT inextrapulmonary TB was forurinary and peritoneal fluid samples. CBNAAT was found high diagnostic yield tool for cases of necrotic lymphadenopathy, psoasabscess, and articular disease with fusion

Objective: This study aims to study the effect of prolonged mechanical ventilation on diaphragmatic functionand to review current knowledge about the impact of prolonged mechanical ventilation on diaphragmatic function and biology. to study the role of the advantage of early weaning off decisions resulting in improved patientoutcomes. Methods: Polytrauma in-patients in the Department of Surgery, MGMMC, Indore, on mechanical ventilation. These patients were assessed for diaphragmatic thickness and excursion through ultrasonography. Results: A total of 100 patients were included in the study period of 1 year. Out of these, 36 patients were discharged and 64 died due to mechanical ventilation for longer duration.  Conclusion: Though ventilator support is lifesaving, it should be used precautionarily, and intermittent ventilator support is much prognostically better in terms of the outcome when compared to controlled ventilation.

Background:  Epilepsy is one of the common chronic conditions affecting women of reproductive age. The rates of maternal death are ten-fold higher in women with epilepsy than those without the condition. Care of women with epilepsy continues to be fragmented, with few units providing joint obstetric-epilepsy care. Objectives: To determine the obstetric and neonatal outcome of pregnancy in women with epilepsy. Material & Methods:  Study Design: Hospital based prospective observational study. Study area: Department of Obstetrics & Gynecology, Mayo institute of Medical Sciences, Barabanki, Uttar Pradesh. Study Period:  June 2022 to May 2023.  Study population:  Pregnant women with epilepsy attending the antenatal clinic at Mayo institute of Medical Sciences, Barabanki, Uttar Pradesh. Sample size:  The study included a target number of 200 subjects with 50 as cases and 150 as controls. Sampling Technique:  Simple Random technique. Results: The percentage of IUD was 6% in cases and 14% in controls, the difference is not statistically significant. The percentage of antepartum hemorrhage in cases was 4%, while it was 3.33% in controls. The difference is not significant statistically. The percentage of abortions in cases was 4% and in controls it was 4%. The difference is not significant statistically. Conclusion: The present study provides reassurance to women with epilepsy that, epilepsy in pregnancy in the majority of women is uneventful. AED use during pregnancy is generally not associated with adverse maternal and fetal or neonatal outcomes, although it is important to be aware that AEDs differ in their teratogenic potential.

Introduction: Atracurium is a benzyl-isoquinolinium, non-depolarizing neuromuscular blocking agent of intermediate duration of action. It has revolutionized anesthetic practice by providing muscle relaxation with faster onset, a more rapid measurable recovery. Cisatracurium is a recently introduced benzylisoquinolinium non-depolarizing neuromuscular drug which is a stereoisomer of Atracurium and constitutes about 15% of the commercially produced Atracurium and with a potency of three to four times greater than that of Atracurium.  Materials and methods: This single center study was conducted in the Department of Anesthesiology at Maheshwara Medical College and Hospital over a period of 1 year. A total of 120 patients, 18-60 years of age. Patients were randomly divided into two groups; Group C received cisatracurium 0.1 mg/kg as muscle relaxant and Group A received atracurium 0.3 mg/kg IV. The mean onset time and duration of action for the two groups was done by Stockholm rules of the pharmacodynamic investigations of muscle relaxants activity. Intubating conditions, hemodynamic changes, and safety profile were noted. Result: In atracurium group, easy jaw opening was seen in 41 patients Comparatively in Cisatracurium group, jaw opening was easy in 45 patients and moderate in five patients. There was no statistically significant difference between two groups (P>0.05). In Group A, vocal cords were found in moving condition in about 35 patients while in 25 patients they were open, easing the intubation. In Group CA, vocal cords movement was seen in Twenty patients. It was found that vocal cord relaxation was better in Group CA, which was statistically significant (P<0.05). In Group A, 34 patients had slight diaphragmatic movement and 16 patients showed complete relaxation. However, in Group CA, 38 patients showed complete relaxation and only seven patients had mild cough reflex.  Conclusion: It can be concluded that intubating conditions are better with 3ED95 dose of cisatracurium as compared to 2ED95 dose of atracurium. None of the participant showed signs of histamine release. Hence, cisatracurium can be considered as more efficacious as compared to atracurium.

Background: All aspects of health status: life style, satisfaction, mental state or well-being together reflect the multidimensional nature of Quality of Life (QOL) in an individual. India has acquired the label of “an aging nation” with 7.7 percent of its population being more than 60 years old. Changes in population structure will have several implications for health, economic security, family life and well being of people. Materials and methods: A community-based cross-sectional study was carried out at urban field practice area of one of the teaching institutes. Considering the prevalence of about 7.5% of 60 years and above people sample size of 250 was calculated. A predesigned questionnaire related to the QOL of elderly people devised by the World Health Organization-QOL was used. Result: Majority of participants were of 60-64 years age group (37.2%). Out of 70 participants, 30 (42.9%) were male and 40 (57.1%) were females. About 55.7% were working and 68.6% married. The overall mean (SD) score was 49.28 (9.92) with first, second and third quartile scores of 45.2, 49 and 53 respectively. The difference of scores between men and women was statistically insignificant. Conclusion: This study showed that determinants such as age <70 years, income sufficiency, depression, social support and affordability to healthcare services have a strong relation with QOL.

Background: This study aimed to investigate the associations between the Occupational Stress Index (OSI) and three chronic diseases, namely Hypertension, Type 2 Diabetes Mellitus, and Lipid Disorders, among middle-aged individuals in Punjab.  Material & Methods: This cross-sectional study was conducted in Punjab, a state in northern India. Data collection was carried out between Jan 2023 and March 2023 in various occupational settings across the state. The data collection process involved both self-administered questionnaires and clinical assessments. The Occupational Stress Index questionnaire was used to assess occupational stress levels among participants. The collected data were entered into a statistical software program (SPSS version 25) for analysis. Results: The study included 400 participants, with an equal number (n=200) of males and females. The average age of male participants was 49.3 years, while for females, it was 47.8 years. The average BMI for males was 25.6, and for females, it was 26.9. The participants were distributed across various occupational sectors, including Manufacturing, Services, Healthcare, Administration, and Others. The prevalence of Hypertension among males was 20.0%, while among females, it was 17.5%. The prevalence of Type 2 Diabetes Mellitus among males was 12.5%, and among females, it was 15.0%. The prevalence of Lipid Disorders among males was 27.5%, and among females, it was 25.0%. The distribution of OSI scores revealed that 27.5% of participants had Low Stress scores, 32.5% had Moderate Stress scores, and 40.0% had High Stress scores. It was found that a higher proportion of participants with Hypertension, Type 2 Diabetes Mellitus, and Lipid Disorders had Moderate and High Stress scores. Participants with chronic diseases had higher mean OSI scores compared to those without chronic diseases, indicating higher levels of occupational stress. Conclusion: The results highlight the need for effective stress management interventions in occupational settings to mitigate the risk of developing chronic diseases.

Background: Vitamin D deficiency is associated with increased risk of coronary artery disease (CAD). However, this association has been the subject of controversial results. Aim: This study was designed to assess the correlation between vitamin D deficiency and severity of CAD assessed with SYNTAX (synergy between percutaneous coronary intervention with taxus and cardiac surgery) score among south Indian population. Methods: Across-sectional, observational study was conducted at a tertiary care center in India between June 2021 and May 2022. A total of 180 stable patients suspected with CAD and having an indication to undergo coronary angiography were included in the study. Baseline demographic and clinical investigations were carried out among all the patients. Risk factors for CAD were recorded. Serum vitamin D level was measured. SYNTAX score was used as an indicator to determine the severity of CAD. Results: Mean age of the patients was 56.6±10.7 years with male predominance (67.2%). Based on the SYNTAX score, patients were categorized into two groups: (a) SYNTAX score <23 (n=122) and (b) SYNTAX Score ≥23 (n=58).Among all the risk factors, vitamin D level (p<0.001) and diabetes mellitus (p<0.001) were found to be statistically significant. A moderately negative correlation existed between vitamin D level and SYNTAX score (r=-0.323). Vitamin D was inversely correlated with the occurrence of CAD (Odds ratio: 0.919; p = 0.001). Conclusion: According to our findings, deficiency of vitamin D may have a crucial role in the occurrence of severe CAD.

Background and Objectives: Bone mass loss is a prevalent issue among the elderly population that often goes unnoticed. Various factors related to reproduction and menstruation, such as parity, breastfeeding, age at first pregnancy, age at menarche, use of combined oral contraceptives, and age at menopause, have been found to impact bone mineral density (BMD). Menarche, marking the onset of menstrual cycles, represents a significant hormonal milestone in females, with variations observed in the age at which it occurs. This study aimed to assess the association between the age at menarche and BMD in women who are either premenopausal or postmenopausal. Methods: The research was carried out at a tertiary care medical college in central India. The study included a total of 106 normal and healthy women ranging in age from 20 to 75 years. Relevant data including age, gender, body mass index (BMI), age at menarche, and BMD values were collected from the participants. BMD measurements were obtained using the DEXA Scan. The obtained readings were subjected to analysis using the Pearson chi-square test.  Results: The findings of the present study indicate a lack of significant correlation between the age at menarche and BMD. Conclusion: Numerous reproductive factors, including the age at menarche, play a crucial role in determining BMD. As such, it is recommended that educational strategies be implemented to enhance awareness regarding the various factors that contribute to maintaining optimal bone health among females. By increasing knowledge and understanding in this area, individuals can make informed choices and take appropriate measures to promote and preserve their bone health.

Background: Pre-anaesthesia check-ups (PAC) are crucial for patients undergoing elective surgical procedures, ensuring optimal preparation, and minimizing complications. Hypertension is a common medical condition in PAC clinics, and poorly controlled blood pressure can lead to dangerous outcomes. Sikkim, a small Himalayan state, has one of the highest prevalence of high blood pressure in the country. This study aims to determine the prevalence of hypertension in Sikkim adults aged 19 to 35 and its associated risk factors to understand disease trends and assess healthcare needs. Material and method: The study included patients aged 19-35 years who were scheduled for elective surgical procedures. Once the patient's demographic data and clinical history were recorded, blood pressure of the patient was measured using an aneroid sphygmomanometer after eliminating all environmental and emotional influences. Questions were asked for presence of risk factors associated with high blood pressure. Patients with a history of hypertension were labelled as "proven cases" and those found to be hypertensive for first time were labelled as "newly diagnosed hypertensive." Period prevalence of hypertension was calculated using suitable formula and compared with national average prevalence of hypertension. Result: The study showed that in Sikkim, the prevalence of hypertension in male patients is   27.9% while that in female patients is 23.74%. This is slightly higher than the national prevalence of hypertension in male and female population of India. Majority of hypertensive patients were found to have risk factors for hypertension. Conclusion: to avoid potentially deleterious effect of uncontrolled blood pressure, Anaesthesiologists must thoroughly examine patients undergoing surgical procedures and ensure that their blood pressure is optimised to prevent morbidities during the perioperative period.

Chronic venous ulcer (CVU) is an ulcer on gaiter area persisting for more than six weeks and difficult to heal even after three months of treatment. The prevalence of CVU ranges from 0.18% and 1% and Standard therapy for CVU is multilayered bandages and treatment of incompetent veins to prevent recurrence. All adult patients having CVU, due to primary varicose veins were randomly allocated to two intervention groups (Group A- comprising of use of compression bandages along with treatment of varicose veins by Endovenous Laser ablation and Group B- Non usage of compression bandages after the aforesaid surgical intervention).Out of 60, total 30 (50%) cases were in each group. Quality of life and therapeutic outcomes were noted, and patients were followed for 6 months. Quality of life outcomes compared based on SF-36 questionnaire showed more improvement in group A in all 8 domains. Other parameters like use of analgesics, itching, eczema, and increased leisure activities were better with use of compression bandages. Healing of ulcer was faster in Group A. Charing Cross varicose vein questionnaire also showed more improvement in group A (p value<0.001, <0.001, 0.003   at 1 month, 3 month and 6 month, respectively).In chronic venous ulcer, four-layer compressive bandaging after surgery enhances the healing rate of venous ulcer with better quality of life outcomes.

Purpose: The purpose of this study was to evaluate children's cognitive and overall performance affected by admission to the pediatric critical care unit. Methods: It was a prospective observational study conducted over a 12-month period at the pediatric intensive care unit (PICU) of the Shyam Shah Medical College, Sanjay Gandhi Memorial Hospital, and Gandhi Memorial Hospital. 200 children (100 PICU admissions and 100 Ward admissions) between the ages of 28 days and 17 years who had been committed to the PICU for at least 24 hours were selected using a technique of purposive sampling. The indicators used to evaluate the child's performance were (i) The Glasgow Outcome Scale, (ii) the Functional Status Scale (FSS), (iii) The Pediatric Cerebral Performance Category Scale (PCPC), and (iv) The Pediatric Overall Performance Category Scale (POPC). Results: A total of 200 pediatric ICU study subjects were included in this study. The majority of them were females. Most of the study population was classified as Grade 1 on the PCPC Score and Grade 2 on the POPC Score. The mean (SD) PRISM-IV score was 4.07 (4.91), the PCPC score was 1.50 (0.98), and the POPC score was 2.30 (1.12) at the time of admission. The mean duration of stay for patients admitted to the PICU was 9.55 (5.82) days, while those admitted to the ward had a mean duration of 6.64 (3.92) days. Most of the study population was discharged in Grade 1 of PCPC and POPC. The mean (SD) PCPC score was 1.82 (1.53) and the POPC score was 2.25 (1.52) at discharge. Conclusion: Compared to patients confined to the Ward, patients admitted to the PICU showed inadequate cerebral and overall performance.

Background: The goal is to reduce or eliminate perioperative pain with as few adverse effects as possible. The mode of anaesthesia that has been proven to be safe and effective in children is regional. In addition to extending analgesia to the postoperative period with minimal sedation (2), the use of inhalational and intravenous analgesics can be reduced. In childern caudal epidural is the regional block infra-umbilical procedures. Objectives:This study was aimed at comparing Bupivacaine 0.125 % (1ml/kg) alone against Bupivacaine 0.125 % (1ml/kg) plus Fentanyl 0.5 μg/kg as a caudal block administered via single bolus in infra-umbilical procedures in children aged 1 to 8 years.Hemodynamic alterations, ie heart rate and blood pressure., and Duration of post operative analgesia after and Adverse reactions are the parameters noted  Material & Methods:  Study Design: A prospective, randomized, comparative study. Study area: Department of Anaesthesia and Critical care, Government Medical college ,Srikakulam ,AP.Study Period: 1 year.  Study population: children, of both gender, posted for infraumbilical procedures of various types. Sample size: study consisted a total of 60 cases. Sampling method: Simple random method.A general, systemic examination, including the airway and spine, was done on the day of surgery also. Vital parameters such as systolic blood pressure, respiratory rate and pulse rate were noted. In addition, investigations such as blood and urine tests, bleeding and clotting times, a chest x- ray if necessary, and viral tests (HIV & HBsAg) were done. Informative and written consent was obtained from the parent. Prior to surgery, restriction was advised for solid foods for 6 hours, milk for 4-5 hours and clear fluids for 2-3 hours. All children were given 1 mg/kg of Promethazine syrup the night before the scheduled operation. Results: The mean duration of analgesia at various time intervals in both the groups was statistically significant. The mean duration of analgesia in the B group (0.125% Bupivacaine) is 5.2 ± 0.85 hrs, the mean duration of analgesia in the BF group (0.125 % Bupivacaine + 0.5 mc/kg Fenyanyl) is 10.8 ± 1.24 hrs. This duration of analgesia is statistically significant as detected by using t test (p = 0.03, <0.05) Conclusion: The present study demonstrated that caudal epidural block with Bupivacaine 0.125% (1ml/kg) plus Fentanyl (0.5 mcg/kg) resulted in analgesia of longer duration and postoperative analgesia when compared with 0.125% Bupivacaine (1ml/kg) alone, with no significant difference in the hemodynamic parameters and the occurrence of side effects.

Introduction: Type 2 Diabetes mellitus (T2DM) is a chronic disease that is characterized by impaired glucose metabolism and Insulin resistance. Leptin is a 16-kDa protein hormone, which is secreted by adipocytes. Plasma Leptin concentration increases in proportion to body fat mass and regulate food intake and energy expenditure to maintain body fat stores. Leptin binds with a Leptin receptor (LEPR) that is located on pancreatic beta cells to regulate Insulin secretion. Materials and Methods: This is a prospective and case-control study was conducted in the Department of Biochemistry at Great Eastern Medical School and Hospital over a period of 1 year. After the inclusion of participants in the study, their demographics such as age, BMI, gender, and smoking history were noted in self-structured questionnaires. Their blood was drawn and sent to the laboratory for Lipid profile levels, Insulin resistance and Leptin levels. The serum levels of Leptin were measured using a Enzyme linked immune sorbent assay (ELISA).  Results: The probable association between Leptin and Insulin resistance in type 2 diabetes mellitus. 60 recent onset (<5 years) diabetics and age-sex matched 60 non-diabetic controls were assessed for physical and chemical parameters. All the physical parameters showed positive correlation with Leptin and the HOMA-IR score, the strength of association being highest between Insulin resistance and abdominal circumference. Leptin and Insulin resistance showed no correlation. Findings were lower in controls.  Conclusion: In our study, significant higher level of Leptin was found in Insulin resistant subjects compared to the subjects without the condition in both genders. This finding provides an insight into the explanation why the metabolic risk was different among persons with same degree of adiposity and may help identify the people at risk for diabetes and/or cardiovascular diseases across adiposity level and thereby an important contribution in clinical and preventive measures.

Background: About 3% of all pregnancies are complicated by one of the many types of hepatic diseases. First, there are a variety of liver problems specific to pregnancy that affect people with previously healthy livers. These include intrahepatic cholestasis of pregnancy, which affects 60% of cases, acute fatty liver of pregnancy, and liver dysfunction linked to hyperemesis gravidum, which affects 50% of cases, and preeclampsia, which affects 12% of cases. Objectives:

1. To determine the maternal and fetal outcome in jaundice complicating pregnancy

2. Find out the measures to reduce maternal& fetal mortality & morbidity.

3. To analyse various maternal and fetal complications which can be prevented

Background:  Stroke is a global and the most frequent cause of disability worldwide. There are many modifiable and nonmodifiable risk factors present. Homocysteine is also a potentially modifiable risk factor. Vitamin B 12 and folic acid are essential for metabolism of homocysteine. There is scarcity of data in Indian population regarding relationship of homocysteine, Vitamin B 12, Folic acid with severity and early neurological deterioration in acute ischemic stroke. Objectives: Our study aims at finding out the relation between serum homocysteine, vitamin B 12, folic acid levels with severity and early deterioration in terms of NIHSS score in patients of acute ischemic stroke. Materials and methods: The study was conducted on 50 patients of acute ischemic stroke case admitted in MBS Hospital, Kota in year 2020-22 and also 50 healthy age and sex matched subjects taken as control.                                                                                                                                          Results: In our study which was aimed to correlate the relation of level of serum homocysteine, serum vitamin B 12, folic acid in case and control group with severity and early neurological deterioration. We found there to be in pathological range and statistically significant. Similarly, NIHSS score correlated with serum homocysteine, vitamin B12, folic acid level in acute ischemic stroke patients at the time of admission, however correlation was found to be statistically significant only with mean serum homocysteine level. There was no correlation found between NIHSS score and mean serum vitaminB12 level and mean serum folic acid level. Also, when we correlated Early neurological   deterioration (END) with mean serum homocysteine, vitamin B12, folic acid level we found no statistically significant correlation between them. On comparing risk factors (hypertension, diabetes, smoking, ischemic heart disease, tobacco chewer, alcohol intake history) with mean serum homocysteine level, mean serum vitamin B12, mean serum folic acid level in acute ischemic stroke patients, we found statistically significant correlation only with vitamin B12 with history of alcohol intake and smoking. Also, we found statistically significant correlation between mean serum folic acid and history of alcohol intake.

Background: India has been experiencing significant demographic, economic and epidemiological transition during the past two decades. The young patients are increasingly affected by stroke, because of both the changing population exposures to risk factors and most tragically, not being able to afford the high cost for stroke care. Age specific incidence of stroke increases progressively with increasing age. Apart from the traditionally recognized risk factors for ischemic stroke (IS), several potential novel risk factors have emerged over the last two decades among which hyperhomocysteinemia (HHC) is one of them.  Methods: A hospital based prospective observational study was undertaken among the adult patients presented with stroke at Dr.Chandramma Dayananda Sagar Institute of Medical Education & Research, Harohalli, Ramanagara from April 2021 - March 2023. Patients with first episode of ischemic stroke in age group 15 years to 45 years of either sex were included. A predesigned, self-administered proforma was designed keeping the objectives of the study at the centre point. Carotid IMT was defined as the distance from the leading edge of the first echogenic line to the leading edge of the second echogenic line on the scans.  Results: Out of total 73 patients, about 78.1% of the study subjects were males and 21.9% were females with male:female ratio of 3.6:1. The maximum study population were between 40 – 45 Yrs (43.8%) with mean age 42.1 ± 2.0 years while total mean age of entire study population was 36.5 ± 6.5 years. 63.1% of the subjects had normal homocysteine with mean 12.5 ± 1.63 µmol/L while 36.9% of the subjects had hyperhomocysteinemia with mean 30.2 ± 11.6 µmol/L. 43.8% of the subjects had ≤0.8 mm of carotid intima-media thickness with mean 0.69 ± 0.07 mm while 56.2% had increased carotid intima-media thickness 1.09 ± 0.16 mm. Conclusion: Identification of newer individual risk factors have not only created a new challenge to the understanding of pathology of MI but have also opened up different approaches other than simply modifying the conventional risk factors in primary prevention of MI. Therefore, the role of newer risk factors has to be identified. In case of our study, serum homocysteine did not show any significant relation with age, sex, DM and diet pattern but goes significant with alcohol habit, hypertension and dyslipidemia.

Background: Since its introduction in 1968, the upper gastrointestinal flexible fibre optic endoscope has proven to be a significant advance in the diagnosis of gastrointestinal tract (GIT) abnormalities.With the advent of flexible endoscopy, there has been a noticeable increase in diagnostic procedures requiring visualisation and biopsy of the upper and lower GI tract.Objectives: To correlate clinical diagnosis with histopathological diagnosis in detecting neoplastic lesions. To correlate endoscopic diagnosis with histopathological diagnosis in detecting neoplastic lesions.Material & Methods Hospital based Observational Cross Sectional Study. Study area:  The present study was carried out on endoscopic biopsy specimens received in the Department of Pathology, at Princess Esra Hospital and Owaisi Hospital and Research Centre; Deccan College of Medical Sciences. Study Period: 1 year. Study population:  Endoscopically directed biopsies were taken from patients with severe upper gastrointestinal symptoms like heart burn, dyspepsia, dysphagia, pain abdomen, vomiting etc. Sample size: study consisted a total of 100 cases. Sampling method: Simple random method.Results: Out of the 100 cases studied, 12 cases were positive for malignancy on histopathology. Out of these 12 cases, 8 cases were diagnosed malignant both on clinical examination and histopathology. 88 cases were negative for malignancy on histopathology, of which 72 cases were negative on both clinical diagnosis and on histopathology. Sensitivity: 66.67 %, Specificity: 81.82 %. Positive predictive value: 33.33 % Negative predictive value: 94.74 %. Accuracy: 80 %, Chi-square test: P-value=0.0025; (The result is significant at P<0.05).Conclusion: Endoscopic procedure in addition with histopathological findings remains the mainstay of diagnostic modality. Our study showed better correlation of histopathological diagnosis with endoscopic findings in detecting lesions of upper GIT. However, endoscopic examination and histopathological study of suspected lesions should always go in parallel and neither of them should be a substitute for each other.

Introduction: Lung cancer has been the most common cancer in the world for several decades. There are estimated to be 2.38 million new cases in 2023 (12.9% of the total), 58% of which occurred in the less developed regions. The disease remains as the 3rd most common cancer in men worldwide. Cancer of the lung has not received much attention in India so far, neither has the carcinogenic potential of tobacco smoke been adequately realized by the general public.11 The prevalence of Lung Cancer is increasing in India along with increase in tobacco smoking habit particularly in rural India.   Material And Methods This is a prospective study consisting of 50 Lung cancer  patients examining the clinical, radiological and Histopathological Profile. The present study comprises of 50 patients who are admitted in the Department of Respiratory Medicine, Kamineni academy of medical sciences and research centre, Hyderabad from April 2022 to March 2023. All the patients having symptoms and radiological features suggestive of primary or secondary malignancy of Lung and Pleura are included in the study. Detailed demographic and clinical parameters including age, sex, occupation, and habits like smoking and alcoholism were taken.  Results: Most common diagnostic modality used was FOB  guided  biopsy  (36%), followed by CT guided trans thoracic biopsy (32%).  Ultra sound guided biopsy was done in 18%. 6% of patients were diagnosed by pleural fluid analysis.  4% were diagnosed by lymph node biopsy and bronchial washings cytology. Squamous cell carcinoma was the commonest histopathological type noted accounting for 48% followed by adenocarcinoma. It was also observed that 10 patients presented with secondary lung malignancy, 3 of whom were presented with lung mass lesions and the remaining 7 patients were presented with pleural effusions. Conclusion: This study has shown smoking as the principal risk factor in the causation of lung cancer among men. Lung cancer should always be suspected in a person presenting with unexplained cough of several weeks with other symptoms such as weight loss and fever with non-resolving collapseconsolidation on chest radiograph, and further investigations should be carried out to rule out lung cancer. Majority of the cases were misdiagnosed as tuberculosis and treated, causing delay in diagnosis. This emphasized the need for more effective methods like FOB, CT for early detection of lung cancer.

Background: Dermatophytosis is most common fungal skin infection observed in dermatology out- patient department. In recent years, the number of patients with dermatophytosis has increased considerably in alarming manner. Aim: To evaluate various socioeconomic factors and risk factors associated with dermatophytosis along with various clinical types and prevalence of dermatophytosis.  Methods: A prospective observational study was done on 899 patients with clinical diagnosis of dermatophytosis visiting outpatient department at JIIU’S IIMS&R Warudi Jalna during October 2020 to March 2021.Detailed history, clinical examination and KOH examination was done. Results: Dermatophytosis was most common in the third decade of life (21-30 years). Male: Female ratio was found to be 1.44:1. Farmers (33.25%) were commonly affected followed by housewives (29.69%). 55.83% patients were residing in a joint family. Family history was positive in 43.59% patients. Diabetes mellitus was the most common disorder associated with dermatophytosis with 187(20.80%).Itching was the most common symptom experienced by 689 (76.64%) patients and use of OTC medications was most common risk factor observed. In both males and females most common clinical type observed was tinea corporis with cruris with 313(59.50%) and 212(56.83%) cases respectively. Direct microscopic examination of KOH mount was positive for fungal elements in 547 (60.84%) cases Conclusion: Increase in awareness among the public to avoid use of OTC products, maintenance of proper hygiene and avoiding wearing occlusive synthetic clothing will help in reducing the burden of dermatophytosis in the community.

Introduction: Hyperpigmentation is one of the most common reaction to inflammatory, benign and malignant lesions of the skin. These disorders comprise heterogeneous group of diseases of epidermal and dermal hyperpigmentation divided into various types according to etiology and pathology. Correct diagnosis of these hyperpigmented lesions is linked to histopathologic examination     of     skin     biopsies     with      clinical      correlation. Aim: To study the spectrum of hyperpigmented skin lesions with reference to age and sex distribution. To study the histopathology of hyperpigmented skin lesions in correlation with clinical features. Materials and Methods: This prospective cohort study was conducted at Department of Pathology, at Alluri Sitaramaraju Academy of Medical Sciences, Eluru,Andhra Pradesh, India, which included 80 patients who were clinically diagnosed with hyperpigmented skin lesions in all age groups from July 2014 to August 2016. Frequency and percentage statistics was used to present the results. Results: Out of 80 cases,34 cases of inflammatory lesions, 23 cases of benign lesions and 23 cases of malignant lesions were reported. Among the post inflammatory lesions the majority were classical Lichen planus. Conclusion: Most common lesion was lichen planus and its variants with highest incidence in females and age group greater than 60 years. Histopathological diagnosis with clinical correlation aids in effective management of the patients.

The present study was a prospective study which was aimed to determine the incidence of age, sex, distribution, etiological factors &mode of head injuries in western UP. This was carried out in Subharti Medical College and associated CSSH hospital on patients of head injury who were admitted during September 2011 to December 2012 and were followed up to 6 months after discharge up to July 2013.There were 823 head injury patients which were admitted in the hospital, 119 were found suitable for study in this group.It was observed that males were more prone to head injuries than females in age groups above 16 years. Below 16 years incidence was same. Maximum number of head injury was caused due to road traffic accidents (67.2%). It was found that maximum number of head injury patients belonged to the age group of 21-40 years (54.6%). Fall from height was the common cause of injury (73.9%) in the age group of < 20 years and among them 52.1% were below 10 years .Road traffic accidents were the major cause of injury among 20-40 years of age group (67.5%). Majority of the accident victims of head injury were two-wheeler riders (56.2%) without helmets, followed by four-wheeler / auto-rickshaw travelers (27.6 %.). People should follow safety rules while driving. Wearing of helmets and seat belts will decrease chances of injury if an accident occurred. Driving and drinking should never be mixed.

Background and Aim- Left atrial enlargement predicts incident atrial fibrillation (AF). However, it is still unknown how well LAS can predict incident AF in volunteers drawn from the general community. Our goal was to find out if LAS might be used to the general population to forecast AF and ischemic stroke. Methods-It was a longitudinal cohort study which included participants examined for cardiovascular disease and risk factors. From January 2022 to December 2022, the subjects received an extensive echocardiographic assessment. Health status and other risk variables had no bearing on whether a participant got an echocardiogram. All individuals provided written informed consent before to the examination. A health assessment involving an echocardiogram was performed on all 1200 participants. Participants who had paroxysmal, chronic, or permanent AF in the past or who were already experiencing AF at the time of study enrollment were not included. Results- 400 participants underwent a health examination. As per multivariable model participants over 65 exhibited considerably lower LAS levels than participants under 65. A decline in LAS reservoir function has already been shown to be one of the first alterations brought on by regular aging. Conclusion- LAS provides more predictive and prognostic information than LAVI for predicting ischemic stroke and AF in the general population.

Background: Exoscopes have emerged as a promising and reliable substitute or supplement to the conventional binocular surgical microscope in procedures such as brain tumour and skull base surgery, aneurysm clipping, as well as complex cervical and lumbar spine surgery. They offer a safe and efficient option, potentially paving the way for a groundbreaking era in the realm of innovative tools and techniques within the field of neurosurgery. Aims And Objectives: The study was conducted to find the practicality, advantages and disadvantages of exoscope assistance rather than use of conventional microscope in ICSOL surgeries. Material And Methods: This Prospective study included patients admitted with intracranial space occupying lesions under department of neurosurgery, GRMC and associated J.A. group of Hospitals from April 2023 to May 2023 who underwent surgery. No randomisation done.  Results: Out of a total of 9 patients, the male population accounted for 57%, while the female population comprised 43%. More than half of the patients, specifically 66.6%, were aged 40 years or older. The prevailing condition among most patients was glioma with a combination of solid and cystic components. During the utilisation of the exoscope, the overall rate of surgical complications was 11.1%. These complications exhibited a similar profile to those observed in patients who underwent the same procedures with the traditional operating microscope. Moreover, there was an overall incidence rate of 11% for switching from the exoscope to the operating microscope during the course of surgery. Conclusion-The utilisation of the exoscope has consistently yielded positive surgical outcomes, surpassing the results achieved with the operating microscope, particularly in surgeries for intracranial space-occupying lesions (ICSOL). The exoscope has emerged as a secure alternative to the traditional operative microscope for common brain procedures, offering several notable advantages. These include user-friendly simplicity, improved 3D visualisation, and enhanced magnification of the surgical field. These advancements have contributed to better surgical results and overall success in ICSOL surgeries.

Background: Encephalocele is a birth defect caused by a neural tube defect in which a portion of the brain protrudes through an opening in the skull. This can cause a swelling or saclike protrusion over the affected area. Occipital encephalocele is the most common type and typically appears as a midline swelling over the back of the skull. It is important to diagnose and treat this condition as early as possible to prevent complications and improve outcomes. Treatment may involve surgery to repair the opening in the skull and reposition the protruding brain tissue. Aims And Objectives: The aim of this review is to provide a comprehensive overview of the current understanding of occipital encephalocele, including its incidence, signs and symptoms, diagnosis, and treatment. By reviewing the existing literature this paper aims to present a consolidated and up-to-date understanding of this congenital condition. Material And Methods: This retrospective study included 24 patients admitted with congenital swelling over occipital scalp under department of neurosurgery , GRMC and associated J.A. group of Hospitals from May 2022 to April 2023 who underwent surgery. No randomisation done.  Results: The study included 24 patients, with 71% being female and 29% being male. Occipital encephalocele has an incidence rate of 1 in 3000 to 1 in 10,000 live births, and about 90% of cases involve the midline. Magnetic resonance imaging (MRI) is considered the best diagnostic method for occipital encephalocele. Surgical intervention is the preferred treatment option for occipital encephalocele. However, the overall morbidity and mortality rate associated with this condition is still high, despite advanced surgical techniques. Nevertheless, recent advancements in high-resolution imaging, proper surgical management, and post-operative care have significantly improved outcomes. Conclusion: Occipital encephalocele is the most common type of encephalocele. Diagnosis primarily relies on neuroimaging. Surgery is the optimal treatment. Despite high morbidity and mortality rates, advancements in imaging, surgical techniques, and post-operative care have led to significant improvements in recent years.

Introduction: Anterior ischemic optic neuropathy (AION) is a sight-threatening condition characterized by the infarction of the optic nerve head. It is a major cause of acute visual loss, particularly in individuals over the age of 50. The exact incidence and prevalence of AION vary across populations due to differences in study methodologies and diagnostic criteria. However, AION is generally considered a relatively rare condition. The incidence has been estimated to range from 2 to 10 cases per 100,000 population per year, with the prevalence estimated at approximately 3 to 10 cases per 100,000 population (1,2). This study aims to provide an overview of the epidemiology of AION, including its incidence, risk factors, and associated comorbidities, to better understand the burden and implications of this condition. Materials and Methods: This prospective observational study was carried out in the Department of Ophthalmology, S.S. Medical College and associated GM Hospital, Rewa, over a period of 18 months among 31 consented patients presenting to the department with features suggestive of AION. Detailed history was recorded and thorough clinical and ophthalmic examination was carried out. Data was collected, compiled and analysed using SPSS 22.0 (trial version). Results were expressed as the means and standard deviation or as numbers and percentages, wherever required. Result:Mean age of patients was 53.34±9.10 years. Male preponderance (54.84%) was observed. Right eye (61.29%) was affected more than left eye. All patients presented with diminution of vision. Only 9.68% experienced jaw claudication, scalp tenderness and headache. History of similar complaints in the fellow eye was given by 29.03%. 78.12% presented within 10 days of onset of symptoms. The most common systemic disease associated with AION was diabetes mellitus (64.52%)followed by hypertension (48.39%). NAION patients had higher incidence of OSA.No patient had history of IHD, TIA or stroke. Mean VA in affected eye was 1.36±0.74 log MAR units.Colour vision of AION patient was defective in almost all patients where it was documentable. Mean number of Ishihara plates read was 5.41±1.55. Mean contrast sensitivity was 0.67±0.43 log units. 67.74% presented with grade 3 RAPD followed by grade 4(16.13%). The most common type of disc oedema was diffuse, and these had poor VA at presentation. Disc at risk was found in 38.71% patients. Fellow eye had a pale disc in 29.03%. Inferonasal field defect was the most common (25.81%) followed by superior altitudinal defect (19.35%). Peripapillary RNFL thickness, average as well as in all quadrants was found to be increased. Conclusion: The data for AION comes mainly from western literature as there have been only few studies in Indian population. Through this study, we aimed to provide an overview of AION, its clinical profile and to study various systemic risk factors associated with it.

Introduction: Patients of 65 years of age and older with Acute Myocardial Infarction(AMI) have a worse prognosis due to co-morbidities and poor treatment facilities This gap is made worse by the low proportion of the elderly in clinical research and the ignorance about the consequences of ageing.. It is yet unknown what external factors have a major impact on elderly   patients' long-term prognosis following myocardial infarction. Aims and objectives: The primary purpose of this research is to assess the possible connections between patient’s age and  its associated  risk factors in case of acute myocardial infarction. Methods: A prospective comparative and descriptive study was conducted on sixty patients who visited our hospital's outpatient clinic. Patients who were below 45 years of age were assigned to Group A and those who were above 45 years of age were assigned to Group B. The baseline characteristics were obtained and other variables were compared. Risk factors of both the groups were evaluated particularly related to hypertension and both the groups were receiving same treatment. Results: Patient related risk factors are presented in Table 1. Sex differences in the sample population were not statistically significant. Risk variables such as high cholesterol, hypertension, triglycerides, LDL- cholesterol, and family history were similar. The majority of smokers were younger than 45. Over 45-year-olds who were obese had diabetes. The prevalence of hypertension was similar across categories and subgroups. Diaphragmatic myocardial infarction was prevalent  in patients older than 45 years of age (Table 3). Conclusion: In conclusion, our research discovered important risk factors for AMI, However, because it was dependent on laboratory analysis, risk assessment methods could not be fully assessed.

Background: Covid-19 has affected the normal lifestyle and emotional aspects of general population of whole world a lot. Due to longer period of lockdown, unhealthy behavior and life style measures has increased like less physical activity, loss of appetite, more fast food and junk food eating habits, sleep disturbances etc.The present cross-sectional study was conducted among 1000 (500 male and 500 female) randomly selected participantsof specific age group from the various areas of Amreli city of Gujarat after taking consent for voluntary participation in the study during March- April 2022.The aim of study was to evaluate the effects of lockdowns on lifestyle and behaviour changes of people in the urban areas in Indian populations.Out of total 1000 participants, 55% were having decreased physical activity, 46.4% were having increase in gain in weight, 44.2% were having increased overall food intake, 40.2% were having increased frequency of ordering food at home, 49.6% were having increased frequency of cooking new or traditional recipes at home, 52.8% were having increased use of social media, 55.2% were having increased screen time (TV/mobile/laptop/tablet), 46.4% were having decreased sleep, 49.6% were having increased anger and 53.6% were having more stress.Unhealthy lifestyle behavior among the participants are gain in weight, increased food intake, increased frequency of ordering food at home, increased use of social media, increased screen time (TV/mobile/laptop/tablet), decreased sleep, more stress and anger. Data derived from this study can be helpful to formulate appropriate interventional measures to the key health care personnel.

Introduction: Among the different ethnic groups in India, diabetes prevalence varies. Microtubule actin cross-linking factor 1 (MACF1) variant rs2296172 has been identified as a type 2 diabetes candidate gene and was found to be associated with T2D in multiple populations. Aim: To study the clinical-biochemical profiles and the mutation in MACF-1 gene variant rs2296172 and their association with type 2 diabetes in Bhargava population.  Methodology: Hospital based cross sectional study was conducted in the Department of Medicine, S.P. Medical College & AGH, Bikaner.144 individuals (34 previously diagnosed type 2 diabetic and 30 non diabetic from Bhargava community and 40 type 2 diabetic and 40 non diabetic from non Bhargava community) were included in the study and evaluated for demography and laboratory investigations. Genetic analysis of these sample for MACF 1 rs2296172 variant gene polymorphism with known primer sequence was done by PCR amplification method at Multi-Disciplinary Research Unit (MDRU) of S.P. Medical College, Bikaner. Results: In our study we found that in diabetic Bhargava (db), non diabetic Bhargava (ndb), diabetic non Bhargava (dnb) and non diabetic non Bhargava (ndnb) respectively mean systolic blood pressure(135.47,117.20,127.00,117.60); mean BMI (27.70,25.16,27.91,22.59); mean waist hip ratio (.96,.93,.96,.87); mean crp (9.42,2.84,4.09,3.14) ;mean HDL (46.72,52.50,51.66,55.02) ; mean LDL (109.47,91.06,69.24,68.66) ;mean cholesterol (186.53,181.67,157.50,148.00).we also found MACF-1 gene rs2296172 SNPs proportion in db,ndb,dnb,ndnb study group respectively is 23.53%,13.33%,17.5%,10%. These result suggest possible role of metabolic,inflammatory and genetic factors in the prevalence of type 2 diabetes mellitus in Bhargava community. Conclusion: Our results and results from other independent cohort studies indicate that Type 2 diabetes mellitus in Bhargava community is more prevalent among elderly respondents and is associated with high socioeconomic status, obesity, dyslipidemia and elevated levels of CRP.MACF-1 rs2296172 variant gene need to be further evaluated in Indian population, so that it can be attributed as a common biomarker of type 2 diabetes mellitus in Indian population.

Background: Stroke is the second leading cause of death worldwide and is defined as a sudden onset of neurological deficit that is attributable to a focal neurological cause. Several risk factors are attributable to the etiopathogenesis of stroke, among which hypertension, diabetes, dyslipidemia, lifestyle changes are modifiable. Hypertriglyceridemia is a risk factor for stroke because of its prothrombotic nature. Aim: The present study was to assess the correlation of serum triglycerides and TG/high-density lipoprotein ratio to the severity of stroke. Methodology: The present study is a prospective hospital-based study of 100 patients who attended the government general hospital between Dec 2017 to Oct 2019 and diagnosed as ischemic stroke based on clinical, imaging, and laboratory findings. Data included Age, Sex, HTN, DM, routine blood investigations, brain imaging, lipid profile, and others when required.TG/HDL-C ratio was categorized into two groups as <2 and >2 and correlated with the severity of stroke. Results: Out of 100 patients with ischemic stroke, majority of the patients (60%) were < 60 years of age, predominantly male (58%). Hypertension, DM, CAD, Smoking and alcoholism were the significantly associated with the severity of the stroke (p<0.05). Serum triglycerides level and highTG/HDL-C ratio (>2) were significantly associated with the severe stroke (p<0.05).  Conclusion: Hypertensions, Diabetes, dyslipidemia, smoking, alcohol, all are significantly associated with the severity of stroke. Serum triglycerides are raised in severe stroke patients than moderate stroke patients significantly.TG/HDL-C ratio is also related to the severity of stroke significantly.

Background: The hospitals have high burden of nosocomial infections,usually caused by multi drug resistant nosocomial organisms.Amongst them Pseudomonas aeruginosa is one of the most difficult pathogens, an epitome of opportunistic nosocomial infections and causes severe and life-threatening infections.This is a compelling problem in hospital settings and needs to have studies on antimicrobial susceptibility pattern to guide the hospital policy on the appropriate use of antibiotics.= Material and methods: A cross-sectional studyat a tertiary care hospital, RIMS, Ranchi, was conducted from October 2017 to September 2018.Phenotypically identified by standard methods (biochemical tests). Antibiotic susceptibility test was carried out by Kirby-Bauer disc diffusion method as per Clinical Laboratory Standards Institute guidelines (CLSI guidelines). Results: A total of 107 samples were processed. Majority of samples were from IPD (69.15%). Among 107 patients, there were 75.70% males and 24.29% females. About 23% of the patients were >50 years of age. The samples mainly comprised of pus (50.46%) followed by urine (30.84 %).Maximum number of pus samples were obtained from general surgery, neurosurgery, orthopaedics, and ENT inpatients.Imipenem (75.70%), Piperacillin-Tazobactam (74.77%), Meropenem (70.09%) in the decreasing order were the most sensitive against P. aeruginosa strains.

Introduction: Dacryocystitis is the inflammation of the lacrimal drainage system which presents as acute dacryocystitis or much commonly as chronic dacryocystitis. The conventional treatment for watering eyes due to Naso Lacrimal Duct (NLD) obstruction is the procedure of external dacryocystorhinostomy (DCR) which has its own limitations and disadvantages. With the introduction of high resolution endoscopes for paranasal sinuses, endoscopic endonasal DCR (EnDCR) is gaining popularity.In EnDCR the most common cause for failure of surgery is closure of rhinostoma and to prevent this silicone tube insertion is the most preferred method.  It has also been claimed that silicone tubing would improve surgical results. But studies also indicate that silicone tubing itself results in certain problems like foreign body sensation, increased granulation tissue leading to failure, prolapse of tube leading to injury to cornea, nasal migration of tube, fistula formation, pharyngitis and associated sinusitis & recurrent nose bleed. The present study was undertaken to compare the surgical results of endoscopic endonasal DCR with and without silicone stent. Aims & Objectives: To compare the success rates of endonasal dacryocystorhinostomy and evaluate the presence of post-operative changes and their effect on the outcome of the surgery in endoscopic dacryocystorhinostomy with and without stenting. Material & Methods: This Prospective randomized comparative study was carried out amongst the patients attending ENT OPD for chronic nasolacrimal duct obstruction with complaint of chronic epiphora. After obtaining approval from the IEC and informed consent of the participants, 50 patients divided into two groups of 25 each fulfilling inclusion and exclusion criteria were included in this study. Group 1 includes patients undergoing EnDCR with stenting and Group 2 includes patients undergoing EnDCR without stenting. Patients were assessed for post-operative complications like granulations, size of the neo ostium and patency of the neo ostium. Data was entered in MS Excel work sheet. Data was analyzed using appropriate statistical methods. Result This study had Female predominance in both the groups. Neither any laterality nor any major intra operative complications were observed. Duration of surgery was more in Group I which was statistically significant. Post-operative complications are seen more in group without stenting (64.0%) than in group with stenting (56%) with no statistical difference between the two groups. Granulations had no effect on the outcome of the surgery. On subjective assessment of symptoms, 92% of patients in group I and 88% of patients in group II showed improvement of symptoms post operatively. No statistical difference had been found between the results of both the groups. On objective assessment of size of the neo ostium, no statistical difference was seen between the two groups. The size of the neo ostium had no effect on the outcome of the surgery. On objective assessment, patency of the neo ostium was observed in 92% of patients in group I and 88% patients in group II with no statistical difference between the two groups. Conclusion: As success rates of the surgery with stenting and without stenting are comparable and stenting leads to increased duration of surgery and additional cost to the patient, we conclude that EnDCR without stenting is the treatment of choice for nasolacrimal duct obstruction (NLDO).

Background: Haemorrhagic stroke is a major cause of mortality worldwide, however, patient outcomes rely heavily on available treatment modalities. There is an abject paucity of medical literature concerning determinants of patient outcome in Andaman & Nicobar Islands, which lie far removed from the Indian mainland, especially since surgical facilities available here are significantly less than those available in the Indian mainland. Aim: To examine clinical outcomes and course of treatment of patients with Haemorrhagic Stroke, within the acute-hospitalisation Department of Medicine, GB Pant Hospital, Port Blair, Andaman & Nicobar Islands.Methods:The study is prospective observational in nature, and follows patients admitted to the hospital in the months of July 2022 to September 2022.Results: Patients treated in GB Pant Hospital, Andaman & Nicobar Islands, were found to be at a statistically significant higher risk of mortality as compared to their counterparts in main-land India (p=0.01615). 85.72% patients, inspite of being advised Neurosurgical evaluation, could not avail it.Conclusion: The authors conclude that in-hospital mortality rate of Haemorrhagic stroke in Andaman & Nicobar Islands is higher than that in mainland India, and hypothesise that the cause for this is lack of Neurosurgical amenities in Andaman & Nicobar Islands.

Background: The prevalence of cervical cancer is increasing day by day. One of the best methods to prevent it is vaccination by HPV (Human Papilloma Virus) vaccine. Now a day’s more and more females are coming forward to take HPV vaccine. Sero-prevalence is one of the best methods to assess disease burden in the community Objectives: 1.  To study sero-prevalence of HPV in adolescent girls.  2. To study association of seroprevalence of HPV with HPV vaccination.  Method:  A community based cross sectional study was performed to assess the sero-prevalence of HPV at two private schools in suburban areas of Hyderabad, Telangana, in April 2022 to September 2022. Blood samples from 100 adolescent girls were collected & analysed for HPV specific antibodies by ELISA. Results:  The sero-prevalence for HPV in the study group was low. There was a statistically significant HPV sero-positivity in all girls receiving HPV (<0.05). An association of sero-prevalence with age was analysed. There was no statistically significant association between age & HPV antibodies (p>0.05 Conclusion:  The prevalence of HPV infection among adolescent girls is low and it is strongly associated with HPV vaccination.

Introduction: Brachial plexus block is a regional anaesthesia technique used for upper extremity surgery that is a safe alternative to GA for upper limb procedures.  Ropivacaine is a new long-acting local anaesthetic which produces less cardiac and central nervous system toxicity. Fentanyl and Tramadol, synthetic opioids are added to local anaesthetics to improve peripheral block quality in peripheral nerve blocks and to extend postoperative analgesia. Tramadol is a weak-opioid receptor agonist and has central analgesic effects and also has peripheral local anaesthetic properties that led to its use as an adjunct in peripheral nerve blocks. Tramadol is a relatively weak opioid with less respiratory depressant effects. With this background, we conducted a comparative study to study the effect of tramadol as an adjuvant to ropivacaine and ropivacaine plain in terms of quality, onset and duration of anaesthesia in supraclavicular brachial plexus block. Methods: The present clinical randomized comparative prospective controlled study was conducted amongst 70 patients undergoing surgery under supraclavicular brachial plexus block during the period of November 2020 – June 2022 amongst the patients between the ages of 18-60 years of age of ASA I and II who were scheduled for elective upper limb orthopaedics surgery. The patients were divided into groups, Group 1 (n=35) receiving 28 ml 0.5% ropivacaine + 2 ml normal saline and Group 2 (n=35) receiving 28 ml 0.5% ropivacaine + 2 ml tramadol (50mg/ml). Results: In the present study among the Ropivacaine group, the majority were of age 51-60 years 23(65.7%) and among the Ropivacaine + Tramadol group, of age 51-60 years 18(51.4%). The onset of sensory and motor block was earlier in Ropivacaine + Tramadol group. The duration of sensory and motor block was more in Ropivacaine + Tramadol group. Among Ropivacaine + Tramadol group According to VAS Score, at recovery, the Mean was 3.25 with an SD of 0.44. Among Ropivacaine group Nausea present among 10(28.6%), Vomiting among 6(17.1%), Bradycardia among 9(25.7. Among Ropivacaine + Tramadol group Nausea present among 6(17.1%), Vomiting among 7(20%), Bradycardia among 5(14.3%). Among the Ropivacaine + Tramadol group, according to the satisfaction of analgesia, was Present among 33(94.3%) and absent among 2(5.7%). Conclusion: We concluded that there was no significant difference between the two groups in terms of hemodynamic changes. The onset and duration of sensory and motor block were better in Ropivacaine + Tramadol group. Post-operative pain management with Ropivacaine + Tramadol was more acceptable by patients. Therefore, its use should be promoted for routine addition to local anaesthetics in peripheral nerve blocks.

Background In this study, we wanted to assess the awareness of screening techniques for detection of carcinoma cervix and utility of HPV vaccine in women aged between 18 years and 65 years. Methods This was a hospital based cross sectional study conducted among 155 women attending the Department of Obstetrics and Gynaecology, Government Medical College, Thrissur, Kerala, India, for awareness of preventive strategies against carcinoma cervix, for a period of one year from January 2022 to December 2022 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants.  Results 85.8% had heard about carcinoma cervix and its symptoms, but only 56.8% believed that ca cervix is preventable. 50.3% had heard about pap smear and 20.6% had actually done the same. No one had ever done HPV testing, 71.6% of them because they had never heard about the test, 23.9 % because it was too expensive. 31% had only heard about the HPV vaccine, but no one had ever taken it mostly because it is expensive (31%) and not in government supply (19%). 77% were only willing to vaccinate their children, mostly because it is expensive. 89.7% were willing to take HPV vaccine if it is in government supply. Conclusion Even though carcinoma cervix is the second commonest malignancy in India around one fifth are not aware of the disease itself. Almost half of the participants do not believe it to be preventable. There is a large gap in knowledge of screening strategy like pap smear and HPV testing. Notwithstanding there exists a knowledge gap in the awareness of HPV vaccine, willingness for vaccination is hampered by its high cost and non-availability in government sector.

Background: Subclinical Hypothyroidism (SCH) is defined by a serum Thyroid Stimulating Hormone (TSH) level higher than the normal reference range associated with a normal serum thyroxine. SCH produces multiple adverse including spontaneous abortion, preeclampsia, gestational hypertension, gestational diabetes, still births, preterm delivery and decreased intelligence quotient. Bad obstetric history (BOH) is defined as women with previous 2 or more spontaneous abortions, stillbirth, IUGR, early neonatal deaths. There is no consensus among different international societies regarding routine screening for thyroid problems and hence the present study was undertaken. Aims:To study the prevalence and association of Subclinical Hypothyroidism in pregnant women with Bad obstetric history. Materials And Methods: A cross sectional study was conducted in 200 women for one year selecting the pregnant women with BOH as cases and pregnant women without BOH as controls.Serum TSH, total T3 and total T4 were measured.Data was analyzed using Epi Info version 7.2.2.6. Results:The prevalence of SCH in pregnant women with BOH was 20%. Women with SCH had history of >2 miscarriages when compared to euthyroid women but difference was not statistically significant (p>0.558). Associated factors like preeclampsia and preterm labour were higher in SCH group when compared to euthyroid women. Conclusion:The prevalence of SCH is high in pregnant women with BOH and is associated with miscarriages, preeclampsia and preterm labour. Hence TSH estimation should be done in all pregnant women with BOH.

Introduction: One in three blind persons worldwide, or an estimated 15 million blind people, reside in India, according to statistics. Out of those 15 million, 3.5 million cases of corneal blindness, one of the most prevalent causes of blindness nationwide with 30,000 new cases reported each year, have been reported. By employing a scientific methodology and disability criteria, the Government of Andhra Pradesh has identified and created a central database for people with disabilities called SADAREM (Software for assessment of the disabled for access, rehabilitation, and empowerment). Aims and objectives To assess Various Causes of Visual Disability Amongst Patients Presenting for SADAREM Certification at GMC/GGH, Srikakulam Materials and methods This was a hospital-based retrospective observational study conducted on 300 subjects who presented to the OPD for SADAREM certification from November 2021 to April 2022. A complete examination was done including testing visual acuity, anterior and posterior segment, and investigations such as tonometry, perimetry, gonioscopy, and OCT whenever necessary.  Results Preventable blindness was found to be 33% and Unpreventable causes were higher (67%) in our study population. 183(61%) patients were from rural backgrounds out of which 13.66% cases were of corneal opacity, 13% cases had Retinitis Pigmentosa, 8.33% had Glaucoma, and 8% Congenital anomalies. Conclusion: Our study found that low hygiene, poverty, lack of awareness, and negligence were the most common factors that contributed to visual impairment. Early diagnosis and treatment of refractive errors and other amblyogenic causes would help to reduce childhood and adolescent blindness significantly. Our study also found a considerable number of bilaterally blind cases of retinitis pigmentosa in our study.

Introduction: Facial skin disorders are a major health problem affecting a high proportion of the population in India. Facial skin disorders can place a heavy emotional and psychological burden on patients that may be far worse than the physical impact. Increased consciousness especially among the youth of their body and beauty further aggravates their anxiety. Many factors determine the pattern and prevalence of Facial skin disorders among the youth such as gender, race, personal hygiene, quality of skin care, environmental milieu and diet.  Materials an methods: This is an observational study was conducted in all age group patients attending at Department of DVL, Government General Hospital, Guntur for a Period of one year from Dec. 2021 to Dec. 2022. Total 424 patients with facial dermatoses belonging to age group birth to old age above and both sexes were randomly selected and included in the study after taking their consent.   Result: Total 424 consecutive patients with newly diagnosed Facial skin disorders attending outpatient department, Government General Hospital, Guntur are examined and data were recorded. In this study, most common facial dermatoses are pigmentary disorders (29.9%), of which melasma constituted the most common, followed by acne, rosacea, and perioral dermatitis (20.3%). 14.6% are infections and 12.7% are eczemas. There is a wide variation in the age group of the cases. In this study, we observed that maximum number of cases are students connective tissue disorders involve Facial skin disorders Conclusion: This study was undertaken to assess the nature and extent of the involvement of the face in various dermatoses at different age and sex. Though the prevalence of various diseases is well known, very few studies exist which have studied face involvement in these. The patients seen in our study were cross sectioned from all age group, both sexes, different socioeconomic status, as well as various geographical areas. It is thus felt that this study provides an insight into various aspects of facial dermatoses encountered in day to day practice.

Introduction: The waste produced in the course of healthcare activities have higher potential for infection and injury than any other type of waste. Therefore it is essential to have safe and reliable method for its handling. Inadequate and inappropriate handling of health care waste may have serious public health consequences and a significant impact on the environment. Due to improper biomedical waste management, lack of awareness and inadequate knowledge, health centres now  a  days  are  source for  spreading infections. Aim: to  assess the  knowledge, awareness and  practice  of  bio-medical  waste management among the health care workers of selected Primary Health Centres of Udaipur district, Rajasthan. Methodology: A health facility based Cross Sectional analytical study was conducted for 6 months from May 2022 to October 2022, at Primary Health centre using multi stage random sampling.  Results: Most of the respondents 56 (90.3%) had knowledge about BMW management and 57 (91.9%) respondents felt it is important to have knowledge about BMW generation, hazards and legislation. Majority of the respondents 61(98.4%) had adequate level of awareness. Conclusion: Majority of the respondents had adequate awareness of BMW management while only half of them had adequate knowledge and fair practice. Lack of formal training reflected a gap in BMW management practices.

Introduction: Left Ventricle being the primary pump of the heart. Left Ventricular Hypertrophy (LVH) has a significant role as a risk and prognostic factor in Cardiovascular and Hypertensive incidences. LVH is a marker of Target organ damage in Hypertension and helps stratifying cardiovascular risk. Electrocardiography and Echocardiography are two of the most important and primary investigations in quickly assessing Left Ventricular Hypertrophy. Although ECG being less sensitive for LVH it is still routinely used. Aim: to determine prevalence of Left Ventricular Hypertrophy  in Primary and Secondary Hypertensive Patients. Method: This was a prospective observational study carried out in the Department of General Medicine, Pacific Medical College and Hospital, Bhilon Ka Bedla, Udaipur, Rajasthan from August 2021 till August 2022. Result: The prevalence of LVH was found to be 54%. Conclusion: The study concluded that LVH development was in 54% of the total patients. The prevalence of LVH was very high and adequate blood pressure control along with regular medication is needed to avoid cardiac complications.

Background: Hepatitis C virus (HCV) infection remains a major public health concern, with more than 100 million people chronically infected worldwide.Direct acting antivirals have revolutionized the treatment landscape for patients with chronic hepatitis C because they have been shown to demonstrate high SVR rates. Objectives: To see effectiveness of Hepatitis C treatment with DAA in CKD and Non-CKD patients in terms of effect on viral load / SVR. Methodology: Medical records of registered hepatitis C positive patients from the Model Treatment Center (MTC) under National Viral Hepatitis Control Programe (NVHCP) MoHFW GOI were taken. HCV Positive patients who have completed DAA Therapy and who have passed at least 12 week after completion of therapy were included. Results: We gave regimen 1 to 29.09% patients while regimen 2 was given to 67.2% patients and regimen 3 was given to 1.82% patients.We found that with regimen 2, 65.4% SVR rate were recorded with 1.82% therapeutic failure. The SVR rate of 29.09% found with regime 1 while 1.8% SVR rate recorded with R3 regime.SVR rate of 63.6% seen after 12 week of treatment while 34.5% SVR rate was observed after 24 week treatment.We found that 97.1% SVR rate was observed in patients with duration of treatment upto 12 week while 100% SVR rate was observed in 24 week treatment time.We found that in patients with CKD 36.3% SVR rate was achieved while in patients without CKD 60% SVR rate was achieved. Conclusions: It is important to note that the high rate of effectiveness about 95% in all age group with the second-generation DAAs, and declined in viral load in more than 99% patients and SVR achieved in about 98% patients after 12-week or 24-week treatment and SVR more achieved in patients without CKD than patients with CKD,  establishing these antivirals as safe and well-tolerated drugs.

Introduction: Tuberculosis is a communicable disease which is caused by Mycobacterium tuberculosis and mainly affect the lungs. Tuberculosis affects both immunocompetent and immunocompromised individuals and is the leading cause of death from a single infectious agent. India is a high burden country for Tuberculosis. India has the target of eliminating Tuberculosis by 2025 under National Tuberculosis Elimination Programme (NTEP). Aims: To Study the knowledge and awareness of Tuberculosis in tuberculosis patients and to Study the knowledge and awareness of NTEP in tuberculosis patients. Material and Methods: The present study was conducted for evaluating the knowledge of tuberculosis and national tuberculosis elimination program in tuberculosis patients visiting the Pulmonary Medicine Department, Government Medical College, Patiala taking antitubercular treatment, tertiary care hospital of Punjab. Result: Out of 501 patients, 97.01 percent of the patients knew when to stop tuberculosis treatment, 28.74 percent of the tuberculosis patients had satisfactory knowledge and awareness of tuberculosis and only 42.71 percent of the patients were aware of the cardinal symptoms of tuberculosis. Conclusion: Almost one-third of PTB patients had limited understanding of tuberculosis. This underscores the need for RNTCP to reform the current information, education, and communication (IEC) system, which is based on a bio-medical framework, and to build a culturally responsive health education system in order to accomplish TB eradication. Instead, the Program should transition from a passive to an active case seeking method.

Background: Electrolytes are present in the human body and the functioning of the heart is dependent upon normal levels of calcium, magnesium, phosphorus, potassium, and sodium. Magnesium, potassium and calcium are three important electrolytes which play an important role in arrhythmogenesis. Hence the present study was carried out with the objective of determining electrolyte imbalance with special reference to the magnesium, potassium and calcium in patients with acute myocardial infarction (AMI) and its association with development of arrythmias in tertiary health care centre in central India. Methods: A total of 134 patients who were presented to the hospital within 24 hours of onset of symptoms of AMI and diagnosed as case of Acute STEMI were included in the study. Patients who don’t give consent were excluded from the study. Results: The mean serum magnesium levels in patients with arrythmias was 1.75±0.23 and in patients without arrythmias was 1.86±0.23 and which was statistically significant. Patients of AMI with low serum potassium levels and low serum magnesium levels were more prone to developed arrythmias than patients with normal serum potassium and magnesium levels. Serum calcium levels in AMI patients were not significantly associated with development of arrythmias. However. the serum magnesium in patients who expired were significantly low (1.56±0.23) as compared to survivors (1.82±0.23). Also, serum potassium in patients who expired were significantly low (3.34±0.44) as compared to survivors (3.73±0.44). Conclusion: Thus, lower levels of serum potassium and serum magnesium in patients of AMI are associated with a higher rate of occurrence of arrythmias and mortality.

Introduction: Liver is the largest solid organ of the body and constitutes 2% of its body weight, varying in adult from 1200-1500 gms. Its functions are remarkably diverse and anatomy correspondingly complex. Liver, probably as a consequence of its anatomic iodation, size, dual blood supply and favorable nutritional elements, is the site of neoplastic lesions, which are greater in number and diversity than. Aims: To study various ultrasonography, CT and MRI patterns of FOCAL liver SOL in arriving at a specific diagnosis before surgery or biopsy, the importance’s of image guided extraction of tissues and fluids for histopathological examination and correlate the radiological diagnosis by histopathological studies. Materials and Methods: It’s an Institution based, prospective, cross sectional, comparative study. This Study was conducted one and half years at the DEPT OF RADIODIAGNOSIS ,KATIHAR MEDICAL COLLEGE , KATIHAR , BIHAR. Total 62 patients were included in this study. Result: It was found that, higher number of the patients had Provisional USG Diagnosis in Hepatic Sol [11 (21.2%)] which was statistically significant (p=.00758) (z=2.6685). In our study, lower number of the patients had Associate Finding in USG in Dilated IHBR [3(5.8%)] which was statistically significant (p< .00001) (z=4.36) and Density & Morphology of Lesions in Ct (p=.13888) (z=1.4825) which was statistically significant. Conclusion: We found that, lower number of the patients had Associate Finding in MRI in Breast Mass but which statistically significant and Histopathological Diagnosis in Carolidisease It was not statistically significant and higher number of the patients had CT & MRI Corroborative (z=5.099) but which statistically significant.

Purpose: To report our experience on lid reconstruction in patients. Methods: This study was carried out in the Plastic Surgery Department of GMC Srinagar between from January 2009 to December 2019. It involved 25 patients, in whom lid reconstruction was done. Results: The records of all patients who underwent eyelid reconstructions were analysed for etiology, site and type of defect, method of reconstruction utilized, post operative complications and the final functional and cosmetic outcome. The study involved 25 patients (20 females and 5 males). Mean age was 57.5 years (range 12- 86 years). Most common etiology of lid defect was post tumor excision All 21 flaps used for partial reconstruction remained viable, whereas 1 of the 10 cheek flaps developed partial distal necrosis. Conclusions: Local flaps are the gold standard for lid reconstruction. KEY WORDS: Lower lid reconstruction, Local flaps, Chondromucosal graft

Introduction: Depression is a psychiatric disorder characterized by depressed mood, loss of interest in activities and loss of energy that lasts for two weeks or more. Type 2 diabetes mellitus (T2DM) is a group of metabolic disorders that share common phenotype of chronic hyperglycaemia. High sensitivity C-reactive protein (hs-CRP) an important sensitive diagnostic and prognostic marker for many systemic inflammatory diseases, as very low concentrations of hs-CRP can be analyzed in the serum.  High prevalence of depression and diabetes mellitus worldwide causes increased morbidity & mortality & have increased economic burden in the community.Pathogenesis of depression and diabetes may be associated with the destruction of brain cells and pancreatic cells resulting from immune and inflammatory mediators.  Studies about the role of inflammation in the pathogenesis of depression and diabetes mellitus, shown conflicting and non conclusive results hence any reliable clue will be considered valuable.  Aims & Objective: To compare the serum levels of hs-CRP in patients of depression with diabetes mellitus and in patients of depression without diabetes mellitus. Materials and Methods: This cross-sectional study included 50patients of depression with diabetes mellitus (case group) and 50 age and gender matched patients of depression without diabetes (control group). Serum hs-CRP levels were measuredfor both the groups.  Results: The mean concentrations of hs-CRP in the case group and the control group were 7.98 ± 1.14 mg/l and 4.52 ± 0.68 mg/l respectively. The difference is statistically significant (P < 0.05) Thus our study yielded higher levels of serum hs-CRP in case group than in control group.  Conclusion: This study has shown that inflammation is more evident inpatients of depression with diabetes mellitus as compared to in patients of depression without diabetes.

Soft tissue defects secondary to hand injuries will involve nerves, tendons, bones with a varying grade, depending the mode of trauma. Hand being the most essential part of the body to carry out day to day activities, it’s defects have to be restored at the earliest to maintain tissue integrity and to allow early rehabilitation. This poses an uphill task to the treating surgeon with respect to type of flap being employed to various types of hand injuries. In our study, the authors present their experience of 25 cases of hand injuries which are being treated with various local flaps with respect to restoration of  optimal functioning hand or any associated complications henceforth. We observed that local flaps provide reasonably good outcome when compared to free flaps which are the standard modality in treating hand injuries. We conclude that the various flaps for hand injuries are  to be selected based on the type of hand injury, degree of soft tissue defects and also the familiarity of the surgeon regarding the particular type of flap.

Introduction: The emergence and increase of Carbapenem resistance in Escherichia coli is now posing a serious threat to human health around the world. Our study aimed to investigate the phenotypic and genotypic detection of Carbapenem resistance among E. coli isolates. Material Method:               The present study was carried out in the Department of Microbiology, Index Medical College, Hospital & Research Centre (IMCHRC) Indore (M.P.). Various clinical samples were collected from the patients attending Medical College, Hospital & Research Centre (IMCHRC) Indore (M.P.). Total 215 E.coli isolates were investigated irrespective of age, sex, departments and Carbapenemase resistance among various clinical samples such as urine, pus, blood, CSF and respiratory secretions received in microbiology laboratory. Results: It is observed that the total 215 isolates of E. coli were included in this study. About 153 (71.16%) isolates were from male patients while 62 (28.83%) were from female patients. The majority (53.95%) of isolates were from urine samples. Out of 215 E. coli isolates, total 63 (29.30%) were carbapenem resistant. Out of 63 carbapenem resistant isolates, maximum carbapenem resistance was found 59 isolates (12.20%) were having Oxa48 gene, 27 NDM (12.55%), 3 E.coli isolates were having gene KPC and 2 E.coli strains were found with both KPC & NDM gene. Conclusion: Carbapenem resistant E.coli are increasing rapidly and becoming major problem in the area of infectious diseases. Early detection of changing resistance patterns is very important in preventing the dissemination of resistant bacteria and modifying the treatment strategies.

Introduction: Methicillin–resistant staphylococcus aureus are among the most common cause of microbial   infections in humans. It encompasses a wide array of infections, accounting for a vast number of community as well as hospital acquired infections in developing countries. Thus, it is of utmost importance to distinguish between hospitals acquired infection and community infection of MRSA which that hospital acquired in complication of MRSA infecting pathogens are more likely to be resistant to antimicrobial agents and lead to higher mortality. Recently, mec C gene has also been found to be associated with MRSA. It code for PBP2c in contrast to PBP2a of mecA gene. Hospital personnel harboring MRSA have been implicated as the chief source of nosocomial infection. Aim: To identify the MRSA isolates from clinical specimens to determine the antibiotic resistant pattern of the MRSA isolate and identify the mec A gene in all resistant pattern strains. Materials and Methods:  It’s cross sectional study from March July 2020 to February 2021 where 150 isolate samples of methicillin resistance staphylococcus aureus (MRSA) isolated from various clinical samples were included in the study in of microbiology department, index medical college Indore M.P. Phenotypic cultures and antimicrobial resistant test was performed from isolated pathogens using Kirby- Bauer disk diffusion method and correlation with genotypic mecA isolates by RTPCR. Results: In our study significant MRSA bacteriuria accounted for 150 (46.6%) were isolated samples.In this study of maximum numbers of isolates were from MRSA in the age group of 30-40 yrs 25 (28.7%) followed by 20 (22.9%) between age group of 50-60 yrs. Among gram positive Cocci in Methicillin resistant staphylococcus aureus was 87 (58%) followed by MSSA 62 (42%). Isolated pathogens were sensitive to linezolid (100%), vancomycin (100%) followed by cotrimoxazole (31%), amikacin (48.3%) and showed higher resistance to penicillin (100%) followed by cefoxitin 87 (100%) in MRSA. This present study MRSA 100% specific were results of mecA gene detection by RTPCR. Conclusion: In this study, male were mostly affected then female and the most common organisms was staphylococcus aureus in gram positive cocci bacteria and sensitive to linezolid, vancomycin and resistance predominantly to Cefoxitin and penicillin. The sensitivity and resistance pattern of to common antimicrobial agents must be taken into account when selecting treatment plans for MRSA. Among RTPCR for mecA genes remains to be rapid molecular method for the evaluation of MRSA. In this study, mecA has been detected in all of the MRSA isolates were 100% sensitivity then phenotypic method, where Cefoxitin of MIC detection by E-strip method were 98.5 sensitivity followed by  cefoxitin disc diffusion method were 97.5 sensitivity.

Background: Scrotal pain is a common urological condition. Common causes of scrotal pain are Hydrocele, testicular torsion, epididymitis, epididymo-orchitis and occasionally due to post vasectomy pain, varicocele, testicular trauma etc. Ultrasound is an ideal imaging modality for the evaluation of scrotum in all age group patients. Scrotal ultrasound can differentiate between solid and cystic masses and localize the mass as either testicular or Para testicular. Objectives: The aim of study is to evaluate causes of scrotal pain on ultrasound and to determine the common causes of scrotal pain. Methodology: Patients presented with scrotal pain who were referred to radiology department of our hospital were included in the study. All patients were subjected to ultrasound of scrotum with color Doppler study when needed. Descriptive variables were studied and analyzed. Results: In the present study out of 160 cases, maximum i.e. 33 (20.62%) patients were ranged in age from 61-70 years. It was observed that majority of cases had hydrocele (35.62%) followed by Non specificorchalgia (26.25%), inflammatory lesion (20%) and others like varicocele (8.1%), torsion infarct (3.4%) Spermatocele (5%), undescended testis (8%). Among 42 cases of inflammatory scrotal pathology, acute epididymo orchitis was present among 12 (28.57%) cases followed by acute epididymitis. Conclusion: Our research led us to the conclusion that hydrocele was the most frequent cause of scrotal pain. For assessing patients with scrotal pathological disorders, Ultrasonography is an excellent, safe, and reliable tool.

This study was conducted to evaluate the natural course of WMH (White Matter Hyperintensities) and lacunes over a period of one year, determine the main MRI representatives of small vessel diseases over time, and evaluate the possible predictors for the development of small vessel disease. Methods This was a hospital-based prospective study conducted among 132 patients who underwent CT/MRI in the Department of Radio-Diagnosis, S.C.B. Medical College, Cuttack, over a period of one year from September 2016 to September 2018 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants.  Results Baseline and 1 year follow-up white matter hyperintensity volume comparisons were found to be statistically significant. The correlation between age and WMH was significant; there was a significant difference in WMH progression among different age strata. The progression of WMH was significantly higher in the age group of 76-85 years as compared to the other two groups. There was a statistically significant correlation between hypertension and WMH progression, diabetes mellitus and incidence of new lacunar infarct, and stroke and incidence of new lacunar infarct. Conclusion The rapid increase in WMH in our subjects supports the potential use of WMH volume as a surrogate marker for small vessel disease progression in elderly individuals. Because WMHs are known to have functional consequences and the volumetric estimation of these lesions is now possible, they can provide an objective measure of outcome of the preventive trials.

Background- Currently, spinal anaesthesia is the preferred mode of regional anaesthesia for gynaecological surgeries as it is easy to administer and economical. Hyperbaric bupivacaine is the most common local anaesthetic in use, but it has short duration of action that may require early analgesic intervention postoperatively. Many additives have been used to increase the duration of action of local anaesthetic and currently dexmedetomidine is being used in different doses. Methods- This prospective, Randomized, comparative, single blinded study was carried out in the Department of Anaesthesiology, MGM Medical Collegeand MY Hospital, Indore, after approval from institutional ethics committee 60 patient qualifying inclusion criteria were included and randomly allocated in twoequal groups  • Group D3(n=30) patients received 3µg dexmedetomidine in combination with hyperbaric Bupivacaine (0.5%) to total volume of 3.5ml through intrathecal route. • Group D5(n=30) patients received 5µg dexmedetomidine in combination with hyperbaric Bupivacaine (0.5%) to total volume of 3.5ml through intrathecal route. Results- The mean duration of analgesia was significantly longer in Group D5 (474.33 ± 24.73 minutes) as compared to Group D3 (389.67 ± 26.97) (p=0.001).The onset of sensory block and motor block was significantly early in Group D5 than Group D3 (P<0.05). The mean duration of motor block was significantly longer in Group D5 (335.33 ± 20.13 minutes) than Group D3 (286.00 ± 21.59) (P=0.001).Analgesic use and intraoperative complications were similar in both the groups. (p > 0.05). Conclusions- Based on the findings and observations from our study, It can be concluded that Dexmedetomidine in a dose of 5µg seems to be a better adjuvant to hyperbaric bupivacaine in comparison to dexmedetomidine 3µg in terms of duration of post-operative analgesia and early onset of sensory and motor block.96

Objective: This study was conducted to estimate the prevalence of significant coronary artery disease (CAD) in patients having severe valvular heart disease (VHD). Our research aims to observe a possible causal relationship between the two.  Methods: A retrospective study was conducted on 100 consecutive patients who underwent surgery for severe VHD in the cardiovascular department of Katuri medical college and hospital between 2019 and 2022. Based on transthoracic echocardiography, patients were divided into 4 groups: patients having severe aortic stenosis (AS), patients having severe aortic regurgitation (AR), patients having severe mitral stenosis (MS), and patients with severe mitral regurgitation (MR). Preoperative coronary angiographies were reviewed for the presence or the absence of significant CAD (50% luminal stenosis). Results: Out of the 100 patients having severe VHD that were reviewed, 5 patients had isolated aortic valve disease, 23 patients had isolated mitral valve disease, and 72 patients had combined aortomitral valve disease. Significant CAD was found in 20% of all patients with severe VHD, in 19.4% of patients with mixed aortomitral valve disease, and in 26.1% of patients with isolated mitral valve disease. Prevalence of significant CAD in patients with severe AS was found to be 43.7%.  Statistical analysis showed a higher prevalence in patients with severe aortic valve stenosis and a significant relationship between CAD and aortic valve disease, mainly severe AS (p < 0.04). Conclusion: The prevalence of CAD in patients with VHD is 20%, and it correlates significantly with severe Aortic Stenosis. Future large studies are needed to evaluate the possible causal relationship.

Introduction: A transfusion transmissible infection (TTI) is any infection that is transmissible from person-to-person through parenteral administration of blood or blood products i.e., packed red blood cells (RBC), platelets, plasma and other blood products. This study was undertaken to assess the prevalence of transfusion transmissible infections among blood donors in blood banks connected to a tertiary care hospital and evaluate the safety of the blood donations. Material & Methods: A total sample of 22,760 which includes voluntary and replacement donors from January 2019 to December 2022 were taken. All the donors who were accepted for donation as per criteria were included in the study. Consent was obtained from blood donors to conduct testing for transfusion transmitted diseases. Donors were screened by 4th generation enzyme linked immunosorbent assay (ELISA) test kits for HIV-1/2, 3rd generation ELISA test kits for HBsAg and hepatitis C virus (HCV)and rapid plasma reagin (RPR) test for syphilis. Test for malaria was done prior to donation by rapid immunochromatographic test. Tests were performed as per manufacturer instructions. All the reactive samples were discarded as per the guidelines. Result: Among 22,760 donors, 930 (4.09%) were replacement donations and 21830 (95.91%)  were voluntary donations. Among replacement units, 3  donors (0.32%) were seropositive for the HIV infection, 32 donors ( 3.44%) were seropositive for HBV infections.  4 donors (0.43%) were seropositive for HCV infections and 2 donors (0.22%) were positive for VDRL. Among voluntary blood donor blood units, 55 donors (0.25%) were seropositive for HIV infections, 377 donors (1.72%) were seropositive for HBV infections 47 donors (0.22%) were seropositive for HCV infections, 36 donors (0.16%)  were seropositive for VDRL infection. Conclusion: Hepatitis B virus (HBV) is the most common transfusion transmissible infection among apparently healthy donors, followed by HIV and syphilis. TTI’s can be eliminated or reduced by implementing an integrated strategy for blood safety, like effective selection of blood donors, avoiding unnecessary transfusions, and early detection of TTI.

Aim: The aim was to study the role of inflammatory markers (IL-6, TNF alpha and C-reactive protein) as prognostic indicator in acute pancreatitis. Method:The study included 76 patients who were admitted in tertiary centre in New Delhi diagnosed as acute pancreatitis for the first time as per Revised Atlanta Classification.Blood samples for inflammatory markers (IL-6,TNF-alpha and C-reactive protein) were sent within 72 hrs of symptoms for evaluation .Later its values were correlated with CECT abdomen  on 3rd and 10 th day. Results : In this  study ,the age of patients involved in this study were between 18-88 years .male predominance was seen in this study(68.4%).The mean C-reactive protein ,TNF-alpha and IL-6 were 145.54,158.47 and 183.44.Modified CT severity score of patients on day 3 was 6(43.4%)where as on day 10 Modified CT severity score was 4 (61.8%).There was a positive significant correlation between Modified CT severity score on day 3 with CRP , TNF- alpha and IL-6. Conclusions: Elevated levels of TNF alpha ,IL-6 and CRP on day 3 are good indicators for  predicting the severity and prognosis of diseases such as acute pancreatitis ,as in our  study it was found that there is a definite correlation between elevated inflammatory  markers and the severity of inflammation of the pancreas.

Gestational trophoblastic neoplasia (GTN) is a rare disease that requires prompt diagnosis for successful management and fertility preservation. This case report aims to present a unique case of GTN with brain metastasis. The study was conducted at RD Gardi Medical College in Ujjain, India, in December 2020. A 22-year-old woman presented with symptoms including headaches, low-grade fever, altered sensorium, and right-sided weakness following a two-month history of amenorrhea. A urine pregnancy test confirmed her pregnancy with a single intrauterine embryo, but an ultrasound examination revealed no cardiac activity. Further investigation through a CT brain scan demonstrated mild hydrocephalus, cerebral edema, and elevated CSF beta hCG hormone levels. The initial measurement of β-hCG level was 192,450 mIU/ml, and subsequent serial estimations showed a progressive increase, leading to the diagnosis of GTN with metastatic brain lesions. The patient underwent treatment with methotrexate, a commonly used chemotherapy drug for GTN, alongside supportive therapy. This case report highlights the rarity of GTN with brain metastasis and underscores the importance of an immediate multidisciplinary approach for comprehensive patient assessment and management. Such an approach ensures the best possible outcomes for patients with this condition.

Background:   In people with CKD, cardio-vascular disease(CVD) is the primary risk factor for morbidity and mortality. This elevated CVD risk may begin in the initial stages of CKD, well before renal failure develops. When analysing CVD mortality in dialysis patients to overall population, the substantial burden of CVD mortality becomes clear. Dialysis cases have a 10-to-30-fold increased CVD death rate. Objectives: To study the Electrocardiographic(ECG) and Echocardiographic(2d-ECHO) changes in patients with chronic kidney disease. Material and Methods: Study Design: Descriptive Cross-sectional study. Study area: The study was conducted in the Department of General Medicine, Gayatri Vidya Parishad Institute of Health Care and Medical Technology, Visakhapatnam. Study Period:  Nov. 2022 – April 2023. Study population: Patients who are admitted to Gayatri Vidya Parishad Institute of Health Care and Medical Technology with CKD. Sample size: study consisted a total of 50 subjects. Sampling method: Simple Random sampling method. All patients had a 12 lead ECG as well as comprehensive Trans- thoracic echocardiography (ECHO) and 2d Doppler evaluation by using GE Medical System's Vivid S5 High Performance Echocardiography machine. The end diastolic volume (EDV), end systolic volume (ESV), and ejection fraction (EF) were calculated using Modified Simpson's approach. An EF of 50% was considered abnormal. Results: In this study, ECG abnormalities were found in 24 patients (48%). LVH was seen in 10 patients (20%). 5 patients had a left axis deviation (10 percent). In 5 patients (10%) conduction abnormalities were observed. 6 patients showed signs of ischemia (12 percent). One patient had an arrhythmia (2 percent). Hypertension was present in all LVH patients. In 3 individuals, left axis deviation (LAD) was associated to LVH (6 percent). Two individuals (4 percent) with serum potassium levels >5.5mEq/L showed signs of hyperkalemia. One patient had atrial fibrillation. Three patients (6 percent) had left bundle branch block, whereas two had right bundle branch block (4 percent). Conclusion: From our study it can be concluded that the most prevalent morphological abnormality was left ventricular hypertrophy. Patients on hemodialysis were vulnerable to conduction abnormalities. The most prevalent cardiovascular abnormality observed was left ventricular dysfunction. Conduction disturbances were more easily spotted with ECG. Myocardial ischemia was more detected with echocardiography. To diagnose LVD, 2d-ECHO was more reliable than any other diagnostic method.

Background: Healthcare professionals must be proficient in Basic Life Support (BLS) and cardiopulmonary resuscitation (CPR) knowledge and skills. Interns and residents are usually the first point of contact in emergency care.The present study aimed to assess the knowledge, attitude and practices regarding BLS CPR among interns and residents.  Materials and Methods: The present cross-sectional observational study was conducted for 2 weeks duration involving 165 participants.The survey comprised of Adult Basic Life Support Knowledge Questionnaire and Student Information Sheet pertaining to socio-demographic information, history of previous training in BLS and history of participation in CPR or BLS practices. Results: Out of 165 participants, majority of participants were females and interns. The mean age of the participants was 23.94 ± 1.505 years in the range of 22 – 27 years.Previous experience in teamwork for CPR was confirmed by 56.97%, though only 49.09% had received formal training for CPR.  Majority gave correct responses for abbreviation of BLS, location of pulse check, clinical characteristics of high-quality CPR, abbreviation of EMS. Lesser accurate responses were obtained in context to symptoms of choking, 2-rescuer CPR, signs of airway obstruction, CPR in neonates and children. The mean score of the participants in knowledge and practice domain were 7.3187 ± 2.2272 and 5.4545 ± 1.8527 respectively. Residents and participants with previous training had significantly higher mean scores in both knowledge and practice domains. Majority gave affirmative responses to the questions pertaining to attitude domain. Conclusions:  The present study highlighted suboptimal knowledge about BLS CPR in among interns and residents. 2-rescuer CPR and CPR in neonates and children were the domains which needed definite attention.  Previous training and experience had positive impact on scores in knowledge and practice domains. There is a need fortargeted educational interventions to indoctrinate healthcare professionals for delivering high-quality BLS services.

Background: Tracheostomy derives its name from the Greek word meaning “I cut the trachea” and has probably been known from about 3500 years BC.  Tracheostomy is one of the oldest surgical procedure in which a stoma is created into the anterior wall of trachea and through which a tube is inserted to facilitate breathing.  Chevalier Jackson established the principles of the operation at the beginning of the twentieth century and these still remain in place today. An Elective tracheostomy is the most frequently done procedure especially in Intensive care units (ICU) for those requiring prolonged mechanical ventilation in critically ill patients. About 24% of all patients in ICU need tracheostomy. Tracheostomy allows for patient mobilization, helps in breathing, physical and occupational therapy and decreases the need for sedation when compared to keeping patients intubated for prolonged duration. The most common indication of tracheostomy has changed from amatory causes in the past to prolonged intubation in the present day. Various modifications of the technique of tracheostomy have reduced complications and deaths due to tracheostomy. The purpose of this study is to highlight the indications of tracheostomy in tertiary care hospital in the light of the relevant literature. Methods: The study consists of 150 patients who underwent tracheostomies in a tertiary care hospital including covid positive patients.  Results:  The most common age group undergoing tracheostomy is 61- 70 years (19%) followed 51-60 years of age group (15%). The mean age for present study is 47 years. Male prepordance is seen with a male: female ratio of 2.2:1.  Dyspnea was the main and chief symptom in all cases. In present study the most common indication is prolonged mechanical ventilation (83%) followed by upper airway obstruction (12%). In prolonged mechanical ventilation, most of the tracheostomies were done for tracheobronchial toileting (32%) in head injury (12%) and in patients with lower airway obstruction (COPD, ARDS) (20%) followed by weaning purpose (28%). In present study, in upper airway obstruction (12%) most cases are of subglottic stenosis (4%) followed by benign and malignant lesions of larynx (3%) and corrosive ingestion (2%). In present study, tracheostomies in 5% of patients were done for anesthesia as a prophylaxis in patients with difficult intubation. 30% tracheostomies were done within 7 days of intubation. 27% tracheostomies were done between 7-10 days of intubation. 43% tracheostomies were done after 10 days of intubation.  Conclusion: The most common indication of tracheostomy is prolonged mechanical ventilation. Indication for tracheostomy in acute infective upper airway obstruction is diminished due to early availability of short term airway intubation and high antibiotics.

Introduction: Corona virus disease 2019 (COVID-19) is highly contagious and has great transmission rate. Growing amounts of research are showing how inflammation affects COVID-19 patients; illness development and mortality. An important aspect of COVID-19 pathogenesis is inflammation. Aim: To study the association of inflammatory markers in COVID-19 patients with and without comorbidity. Materials and Methods: The study was conducted in the Department of Physiology and Department of Respiratory Medicine, SGRRIMHS, Dehradun, prospectively in COVID-19 patients who were admitted to the Department of Respiratory Medicine, Shri Mahant Indiresh Hospital, SGRRIMHS, Dehradun, COVID ward with positive RT PCR (real-time reverse-transcriptase-polymerase-chain-reaction) test. Blood samples were taken at the time of admission for laboratory assessments of inflammatory markers i.e. CRP, Ferritin, LDH, D-Dimer, and Procalcitonin. Results: CRP, Ferritin, D-Dimer, and LDH levels were raised in all Covid patients whereas the levels of Procalcitonin were within the normal range. The levels of CRP, Ferritin, D-Dimer, and LDH levels were raised more among Covid patients with comorbidity as compared to Covid patients without comorbidity. Serum Ferritin and LDH levels were statistically significant among patients with comorbidity [p < 0.05]. Conclusion: CRP, Ferritin, D-Dimer and LDH were raised among Covid patients with comorbidity and the levels of Ferritin and LDH were statistically significant among Covid patients with comorbidity.

Background:   Several challenges with radiation protection and safe practice in radiology departments needs to be addressed as very few studies are done in this aspect in our country. Especially with regard to General radiology safety and those necessary radiation protection and hazards. Objectives: To know the existence knowledge about radiology safety among Hospital staff. To create awareness about Radiology Safety among Hospital staff in tertiary care institution of Middle Gujrat, India. Methodology: The Healthcare Professionals who are willing to participate were included in this descriptive cross-sectional survey. Questionnaire to test knowledge of Hospital staff pertaining to radiology safety was created. Google link was created to share the questions to the Hospital staff. Participation were voluntary. Minimum 100 response were collected to analyse the data. Data was analysed using response sheet in google form. The validity and reliability of the used questionnaires, which asked both specific and generic questions, had been established. Results: The survey included 136 healthcare professionals in total. The majority of participants, who are often between the ages of 20 and 35, have excellent awareness of radiology Procedure as well as safety. Maximum were intern doctors (41.9%) followed by Junior resident doctor (27.9%). Majority Hospital staff  having adequate knowledge regarding indication/contraindication as well as allergic reaction of contrast media used in various radiological procedure. Conclusion: Depending on the professional duties, amount of training, and even country of healthcare practitioners, awareness and knowledge of radiation threats may vary. The current findings showed that the present group had a high level of awareness regarding radiation risks generally. The results of the survey show that there needs to be more focus on providing all medical workers with extensive and systematic training in radiation protection.

Background: Cervical cancer is the third most common cause of death among women in developing countries including India. To decrease morbidity and mortality associated with cervical cancer, a pap smear screening test is advised before the age of 45 with or without symptom. The aim of the study is to evaluate Pap smear screening method for detection of precancerous lesions of cervix in symptomatic women. Material and methods:The study was conducted over one year period with effect from Jan 2018 to Dec 2018. A total of 1680 cases were received. Out of 1680 cases only 466 cases were included for this study on the basis of inclusion and exclusion criteria. A detailed history was taken in all the women and that included personal information, history, and clinical examination. Smears were made with the conventional method according to standard medical literature and stained with Ultra-Fast Papanicolaou Staining kit. The stained slides were reported according to the Bethesda Classification system (2014).  Results:None of the women who participated in the study had pap smear testing earlier in life. Majority of women included in the study were in the age group of 41- 65 years with a mean age of 38.93 years ±12.66. Seventy-seven women among the 466 cases had achieved their menopause. Out of the 466 cases, 448 (96.1%) were parous and 18 women(3.9%) were nulliparous. The commonest presenting complaints in our study was white vaginal discharge which was in 182 (39.1%) cases followed by abnormal bleeding per vagina in 60 (12.9%) cases and pain abdomen in 46(9.9%). On microscopy 320 (68.7%) cases were reported as negative for intraepithelial lesion or malignancy(NILM), 9(1.9%) as high grade squamous intraepithelial lesion(HSIL), 5(1.1%) as low grade squamous intraepithelial lesion(LSIL), 6(1.3%) as Atypical squamous cells of undetermined significance( ASCUS), 6 (1.3%) as squamous cell carcinoma(SCC), 3 (0.6%) as Atypical squamous cells-cannot exclude HSIL(ASC-H) and 1 (0.2%) as atypical glandular cells-not otherwise specified(AGC-NOS) respectively. Conclusions: With increasing awareness of pap test among the women by education can significantly reduce treatment burden, morbidity and mortality.

Introduction:  Butorphanol   is a   synthetic opiod agonist on   κ (kappa)     receptor   and antagonist   or partial agonist on   μ (mu) receptor.  Epidural   Butorphanol   has   been   used   successfully for post operative pain relief.   It is  safer  than  pure   agonist   opioids  because   of   its  ceiling   effect   on  respiratory    depression,  lower  addiction   potential,  lesser  nausea , vomiting,   pruritus  and  also   produces   sedation .  Nalbuphine   is   antagonist of μ   and   κ receptor   agonist. Aims and  Objectives : To    compare   the   effects   of   Butorphanol   and    Nalbuphine    with   Bupivacaine  given in   epidural   route   as  adjunct  to   spinal  anesthesia   in  infraumbilical  gynecological surgeries   for   post   operative   analgesia.  Materials and Methods: This study was done in Department of Anesthesiology of M.K.C.G Medical College from June 2021 to August 2022, Berhampur, Odisha; India. Total of 80 female patients of age 15- 50 years of ASA grading I & II were scheduled for elective gynecological surgeries under combined spinal and epidural anesthesia(CSE).  On the day of surgery the selected cases were randomly placed into two groups of 40 each; Group-B: received 10 ml of 0.125% Bupivacaine+1ml(1mg) of butorphanol and Group-N: received 10 ml of 0.125% Bupivacaine+1ml(10mg) of Nalbuphine. Operation was allowed after achievement of block height up to T8. After 2 segment regression of block height i.e T8 to T10, total amount of drug studied were injected to group-B and group-N respectively. Vital parameters such as heart rate, BP, respiratory rate and SpO2 were monitored every 5 minutes for next 30 min, every 30 min for next 2hrs and 2hrly for next 12hrs postoperatively. Onset time, duration and quality of analgesia was recorded using visual analogue score (VAS) and compared in two groups.  Results:  No significant difference in  mean heart rate(MHR) from 0 minutes to 360  minutes  between  both  the groups  B and  N. MHR in group-B  was  83.65/min and  group-N  was  80.40/min  at 480 minutes(p =0.02)  which is statistically significant. Mean Arterial Pressure (MAP) of both the groups are comparable from 0 to 240mins and are not statistically significant but p-value of MAP in 360 and 480 mins was < 0.05 and this change is blood pressure might be due to onset of pain between 120 to 240mins in group-N and 360 to 480 mins in group B. The mean onset of analgesia was 6.20 minutes and 6.50 minutes in group-B and group-N respectively. The mean duration of analgesia was 398.45 minutes in Group B and 222.88 minutes in Group N. The duration was significantly longer in butorphanol group. Among all, 37 cases (92.5%)  and 38 cases(95%) have good pain score on evaluation after 30minutes of administration of epidural drug which is statistically significant followed by 3 cases(7.25%) and 2 cases(5%) have fair pain score  from group-N and group-B respectively. Sedation as side effects found in 85% and 50% of cases butorphanol and nalbuphine group respectively. Current study shows that 10% of cases in group-B and 5% cases in group-N had nausea and vomiting, which is major side effect of nalbuphine group. No patients in nalbuphine group and butorphanol group had pruritus in this study.  Conclusion: Opioid analgesics with local anesthetics are extremely safe, effective and reliable method of post-operative pain relief. Epidural Butraphanol  in a dose of 1mg with 0.125% bupivacaine, provides  longer duration of analgesia with better pain score and more sedation which is  advantageous for post operative patient as compared to 10 mg of  Nalbuphine with 0.125% bupivaine.

Objective:  The aim of this study was to compare total antioxidant Levels in Patients with Type 2 Diabetes Mellitus. Materials And Method: A case control study was undertaken in a medical care hospital to find out the antioxidant status in patients with Type 2 Diabetes Mellitus compared to normal healthy subjects, significance of estimation of serum vitamin C and vitamin E levels as indicators of antioxidant status and development of diabetic complications due to their deficiency.  The fasting Blood sugar (FBS), HbA1C, Vitamin C, Vitamin E, Serum total cholesterol, serum triglyceride (TGL), and serum high density lipoprotein (HDL) were estimated. Results: The level of antioxidants (vitamin C and vitamin E) is decreased in Type 2 Diabetes Mellitus which is more in case of diabetes with complications. Antioxidant status can be used as an indicator of severity complication and duration of Type 2 Diabetes Mellitus. Conclusion:  Diabetic patients also have a well documented defect in antioxidant protection which have been studied by various research workers, and in the present study also it is seen that the level of antioxidants in the complicated cases of Type 2 Diabetes Mellitus are remarkably lowered when compared to the Type 2 Diabetes Mellitus without complications

Introduction: An air conditioner is a home appliance, system, or mechanism designed to extract heat from an area via a refrigeration cycle. In construction, a complete system of heating, ventilation and air conditioning is referred to as HVAC. Its purpose in a building or an automobile is to provide comfort during either hot or cold weather. While the absence of air conditioners and use of hot water heating systems is also reported to have a negative relationship with FEV1. Increased prevalence of Ig G induced sensitization and hypersensitivity pneumonitis is reported in persons exposed to aerosols of contaminated AC. While fluorinated hydrocarbons collectively referred as FREONS have been shown to result in widespread toxicity after accidental or intentional inhalation.  Materials and Methods: The present study is planned to assess the effect of air-conditioner on pulmonary functions in young healthy nonsmokers from April 2022 to March 2023 among Bank employees working in Srikakulam. The present study was conducted in Bank employees on 50 subjects using AC. The indoor temperature was maintained constantly between 18 and 220c. The study group comprises of 50 subjects who are exposed to AC for at least 6-8 hours daily for 1 year between the age group of 18-45 years, while 50 subjects who did not use AC at all served as controls. The pulmonary functions were assessed using Medspiror with built in computer programme using the standard laboratory methods. Results: In our study 50 apparently healthy subjects between the age groups of 18-45 years who were working using AC were selected for this study, among whom 65 subjects were male and 35 subjects were female. Another 50 subjects who did not use AC at all served as controls. Among controls 35 were males and 15 were females. The anthropometric parameters of the subjects and the controls when compared no statistical difference was observed both in males and females between the two groups on these parameters. The  mean  value for  FVC  in  male  subjects  was 2.73 and in the controls was 3.41. The difference in FVC between the two groups was significant.  Where as in female subjects the mean value for FVC was 2.2 and in controls 2.11. Conclusions: The lung functions particularly FVC, FEV1, PEFR, and MVV are affected more in AC users. This result is suggestive of predisposition of AC users towards respiratory disorders in the form of “Mild Air Flow Restriction”.  The long duration of exposure appeared to have contributed individually in lowering the lung functions. Restrictive type of pathology is more prevalent than obstructive type of pathology.

Background: In the early neonatal period, respiratory distress affects up to 7% of new-born babies. (1) The respiratory distress syndrome and chronic lung disease of prematurity in preterm new-borns (gestational age 37 weeks) have received a lot of attention (2,3), but many term-born infants are brought to neonatal units each year for the care of their respiratory distress. OBJECTIVES: • To estimate the incidence of respiratory distress in term neonates. • To know the risk factors of respiratory distress in term neonates. • Evaluation of outcome of respiratory distress in term neonates during their hospital stay. Material & Methods: Study Design:  Hospital based prospective observational study Study area: The study was conducted in the Department of Paediatrics, Mallareddy institute of medical sciences, Hyderabad, Telangana. Study Period: Oct. 2022 – March 2023. Study population:  Term neonates admitted to Inborn and Out born NICU. Sample size: Study consisted a total of 100 subjects. Sampling Technique:  Simple Random technique. Results: In this study, out of 100 babies with respiratory distress, 30 babies (30%) had Downe’s score of 2; 30 babies (30%) had a score of 3; 11 babies (11%) had a score of 4 and 19 babies (19%) had a score of 5. Inference was that most of the babies with respiratory distress had a lower Downe’s score in the range of 2-4. It was found that, 84 babies (84%) had a perinatal risk score of 0 – 3.  Conclusion: From our study we conclude that there was a highly significant association between Caesarean extraction and RD. Frequency of RD is inversely related to gestational age and birth weight. 74 babies admitted with respiratory distress required only Oxygen, whereas 5 required mechanical ventilation and 32 required CPAP. 97% survived and 3% died in the present study. k score of 0-3.

Objective: Obesity has been associated with pulmonary dysfunctions in not only morbid but also in mild obesity. The respiratory morbidity in obese persons is due to alterations in respiratory mechanics and decreased respiratory muscle endurance. An observational cross sectional study was planned to find out the association between parameters of obesity measured by anthropometry such as  body mass index(BMI), waist circumference(WC), waist/height ratio(W/Ht), waist/hip ratio(WHR) and total body fat %(BF%), & lean body mass(LBM) with spirometry functions in college students.  Material & methods: The study was approved by the Institutional ethics committee. Body fat % and LBM was assessed by bioimpedence analysis using Quadscan 4000 bodystat machine (Isle of Mann UK). Lung functions were assessed under the guidelines of ATS with the help of spiroexcel software (physiopac pp4,16 channel polygraph machine).  Results: A significant negative correlation was found between BF% & FVC, FEV1, MVV, FEF 25-75%. Lean body mass (LBM) showed a strong positive correlation with FVC, FEV1, MVV, and FEF 25-75% in adolescent girls. For adolescent boys, body weight was negatively correlated with FVC & FEV1. The BF% was strongly negatively correlated with MVV & FEF 25-75%. LBM was positively correlated with FVC, FEV1, FEV1/FVC, MVV & FEF 25-75%. Conclusion: The BF % had a stronger correlation with spirometry functions than BMI, thus suggesting that BF% was a major determinant of the reduced pulmonary functions in adolescent age group than BMI.

Background: “Non Alcoholic Fatty Liver Disease” is one of the most quotidian liver diseases in the entire world. The risk factors for developing “Non Alcoholic Steato-Hepatitis” or (NASH) include – 1) Obesity, especially Central Adiposity, 2) Impaired Glucose tolerance,3) ‘Type 2 diabetes mellitus’ (T2DM), and 4) Dyslipidemia. Material And Methods: A total of 65 NAFLD patients, both male and female, were included in the research study. ‘Type 2 diabetes mellitus’ diagnosis was made according to ADA criteria which includes – (1) symptoms of diabetes mellitus plus random blood glucose concentration more than equal to 11.1mmol/L(200mg/dl); (2) Fasting blood(plasma) glucose more than 7.0mmol/L(126mg/dl); (3) Two hour plasma glucose more than equal to 11.1 mmol/L(200mg/dl) on oral glucose tolerance test (OGTT). Results: This study shows Association of and PP blood sugar levels with hypertension and obesity. It shows mean ± SD (175.57±72.50) of fasting blood sugar in NAFLD hypertensive subgroup was found to be higher as compared to NAFLD without hypertension mean±SD (133.43±68.06). This was statistically significant(p=.020).Mean±SD(292±107.62) of Post Prandial blood sugar in NAFLD-hypertension subgroup was found to be higher than the Post Parandial blood sugar of NAFLD without hypertension & this was statistically significant(p=.04). The mean±SD(175.12±77.50) of fasting blood sugar of Obesity fasting subgroup of NAFLD were higher as compared to mean±SD of those without obesity(138.0±63.78). This was found to be statistically significant. Conclusion: The present study concludes that higher fasting and postprandial glucose level were significantly associated to NAFLD in hypertensive patients compared to non hypertensive NAFLD patients. Also significant higher fasting glucose levels were associated with obese patients having NAFLD compared to non obese patients having NAFLD. Timely assessment and analysis of NAFLD at a mild stage or at a moderate stage with appropriate and adequate lifestyle changes of the patients such as (1) physical activities and (2) proper diet could thus indirectly prevent the occurrence of pathological states including ‘type 2 diabetes mellitus’, obesity and metabolic syndrome. Future research with bigger study sample are needed for more concrete and decisive outcomes.

Background: Cord blood TSH estimation has the benefits of being easy to collect, non-invasive and low rates of follow up loss as the results would be obtained at an earliest, enabling repeat sampling if required. Various maternal and perinatal factors are known to affect TSH levels. Objective: To analyse umbilical cord blood TSH levels of new borns and its association with perinatal risk factors. Materials & Method: A total 200 pregnant women who delivered by normal vaginal delivery, caesarean section. 5 ml of umbilical cord blood was collected in a red top vial from the placental end within five minutes of delivery. Samples were allowed to clot for 30 min, separated by centrifugation at 3500 rpm for 5 min then the serum was aliquoted. Finally, biochemical analysis was done on it and cord serum TSH level was estimated by chemiluminescence immunoassay (CLIA) Results: On evaluating the variables, gestational age with cord blood TSH among 200 samples, the mean among term babies in 170 samples were found to be 7.8mIU/L, and for preterm babies it was 12.0 mIU/L out of 30 samples. When comparing mode of delivery with cord blood TSH among 200 samples, the mean among babies born by elective LSCS in 151 samples was found to be 6.4 mIU/L, for emergency LSCS in 36 samples were 18.3mIU/L, and for normal vaginal delivery (NVD) it was 8.1 mIU/L out of 13 samples. Conculsion: The incidence of congenital hypothyroidism in our study is much higher when compared to other countries across the globe. Deferment in diagnosis can lead to lifetime intellectual impairment. Estimation of umbilical cord blood TSH is a practical, an easily available alternative for screening of congenital hypothyroidism.

Introduction: Cardiovascular disease is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD).  Objective: To study the cardiovascular events in chronic kidney disease patients and to correlate the events with various stages of CKD, events with the duration of CKD and to study the in-hospital mortality in them. Methods: This is a cross-sectional observational study conducted on stage 3 to 5 CKD patients at a tertiary care hospital. 106 patients are enrolled from March 2021 to September 2022 and evaluated for cardiovascular events. Baseline data, comorbidities and in hospital mortality are determined. They are correlated with the stage of CKD and duration of CKD.  Results: The mean age of the study population is 52.16± 13 years. 63.2% patients are males and 36.8% are females. 57.5% patients are in stage 5 CKD. 34% patients presented with cardiovascular events. The most frequent cardiovascular event is sudden cardiac death (10.3%) followed by acute decompensated heart failure (6.6%). In stage-5 CKD, 75% patients have cardiovascular events (p value <0.033). In patients with CKD duration >2 years, 50% have cardiovascular events (p value <0.00001). 13.2% is the in-hospital all-cause mortality and 78.5 % of mortality is attributable to cardiovascular events. Conclusion: Cardiovascular events increases as the stage and duration of CKD progresses. cardiovascular events are the major determinants of in-hospital mortality in chronic kidney disease patients.

Introduction: Thyroxine (T4) and triidiothyronine (T3), two related hormones produced by the thyroid gland. Thyrotoxicosis, a condition in which the thyroid gland produces too many thyroid hormones, or hormone shortage, which results from glandular damage (hypothyroidism). Objective: The objective of the study was to examine the effect of thyroid hormone replacement (L thyroxin) on left ventricular diastolic dysfunction in patients with overt hypothyroidism. Materials and Methods: The present study was a case-control study. This Study was conducted from April 2021 to November 2022 at Department of General Medicine at PMCH, Patna. Result: Serum TSH level showed a significant decrease in patients from 56.458m Iu/L (±13.032) to 17.932mIu/L (±11.040) after 3 months of L- thyroxine therapy. Serum T3 & T4 showed a significant rise in patients from 0.838 (±0.035) Nmol/L to 2.069 (±0.036)Nmol/L and 44.678 (±8.673) Nmol/L to 92.358 (±13.011)Nmol/L respectively after 3 months of treatment. Conclusion: In conclusion, diastolic dysfunction of LV is abnormal in patient in hypothyroidism, which can be reversed by L-thyroxine therapy. Doppler echocardiography is reliable, simple, and inexpensive method for assessment of diastolic dysfunction.

Introduction: Gallstones are a major cause of morbidity throughout the world, necessitating hospitalization and cholecystectomy. Gallbladder is known to play crucial role in the formation of gallstones. Therefore, understanding the interaction between gallbladder mucosa and bile is an important step towards understanding the pathogenesis of gallstone disease. Aims: Qualitative and quantitative assessment of gallbladder mucins in chronic calculous cholecystitis and Correlating the mucin histochemistry and morphology of gall bladder in chroniccal culouschole cystitis with each otherand with the chemical composition of gallstones Materials and methods: The present study was a Prospective, Observational institutional based study. This Study was conducted for the duration of 18 monthsat DarbhangaMedical College and Hospital, Laheriasarai, Darbhanga.Total110 patients were included in this study. Result: In the present study, pigment stones were found more often in association with severe inflammation, gastric metaplasia and increased expression of sialomucins,as against cholesterol stones. Conclusion:The normal gallbladder epithelium contains sulphated acid mucins with traces of neutral and sialomucins .The sulphomucin content decreases in chronic calculus cholecystitis

Introduction: In the beginning of year 2022, India facing the third wave of Covid19 experiencing the all time high number of Covid19 cases throughout the nation. This is need of the hour to know who are more prone to this latest variant of SARS CoV2 - Omicron (B.1.1.529). Aim and Objective: The present study was aimed to analyze the association of age, sex and ABO blood group with the seroprevalence of anti-SARS-CoV-2 IgG antibodies among healthy blood donors during the 3rdwave of the COVID-19 pandemic in India, to monitor and help in planning restrictive and preventive measures for COVID-19 infection. Material and Method:This was a blood centrebased, cross-sectional,sero-prevalence study conducted on blood donorsduring the 3rd wave of the Covid-19 pandemic (Jan-April 2022) under the department of IHTM at Government Medical College, Kota (Rajasthan) India; after getting the permission from the Departmental Research Committee and Institutional Ethical Committee.All participants were healthy blood donors who donated blood atthe blood centres underGovt. Medical College and Attached Group of Hospitals, Kota, during Jan 2022 to April 2022. Samples were tested for the SARS-CoV-2 IgG antibody by using CE-markedErbaLisa COVID-19 IgG Antibody Detection ELISAkits based on the principle of indirect ELISA using recombinant spike subunit antigen, developed by Erba Mannheim and Calbiotech. Optical density was measured by calorimetric reaction at a reading wavelength of 450nm to detect the reaction between SARS-COVID-19 IgG Antibodies and Antigens.The statistical analysis was done using IBM SPSS software version 22.0.P-value<0.05 was considered statistically significant. Results:In the present study,1320blood donors were enrolled andscreened. Out of them, 97.6% (1288/1320) were found sero-reactive and remaining 2.4% (32/1320) were nonreactivefor SARS-CoV-2 IgG antibody. Most of them were male donors 1280(97.0%) and female donors were very less 40(3.0%).No statistically significant correlation could be established between age, sex and blood group of the blood donors and sero-reactivity(P=1.000; 0.624 and 0.938 respectively). Conclusion:Present study concludes that majority of the population has beenalready exposed to SARS-CoV-2 infectionand widespread coverageof covid-19 vaccination and immunity (SARS-CoV-2 IgG antibodies) develops afterCovid19 infections and its vaccination, irrespective of persons’ age, sex and blood type (ABO RhD).

Introduction: Palmoplantar dermatoses are commonly observed in the dermatological department and most difficult of all dermatological therapeutic problems. The physical activities of patients are impacted negatively by lesions on the palms and soles, which in turn affects their quality of life. The present study has been done to study the epidemiological and clinical aspects of the common dermatoses of palms and soles Aim of the Study: To study the clinical aspects and frequency of occurrence of various palmoplantar dermatoses and to study their epidemiological aspects like age, sex and occupation.  Methodology: A Cross-sectional study was done on 200 patients with skin lesions involving palms, soles or both attending the dermatology department, tertiary care hospital for a period of one year. After taking consent, detailed history and examination was done and investigations like KOH, Gram stain, patch testing, and skin biopsy wherever necessary were done. Results: Among the 200 patients, 107 were females and 63 were males. Palmoplantar dermatoses were commonly found in the 31-40 years age group. Housewives(29%) were frequently affected. Keratolysis exfoliativa(19.3%) was the common condition affecting only palms, candidiasis (30.2%) was the common condition affecting only soles and palmoplantar psoriasis (34.8%) was common with palm and sole involvement.  Conclusion: It is important to recognize subtle clinical differences between them through careful observation so that necessary investigations can be done wherever needed, early diagnosis can be made and appropriate treatment can be given and thus improving quality of life of the patients.

Introduction: Parkinson‟s Disease has been known in India since ancient times. Parkinson‟s Disease is a progressive neurodegenerative disorder characterized by clinical features of bradykinesia, tremor and rigidity. Nearly all forms of PD results from a reduction of Dopaminergic transmission within the Basal ganglia. Aims: To study clinically around 50 patients of Idiopathic Parkinson‟s Disease having non- motor manifestations in and around Patna, Bihar, having a mixed population and the clinical correlation, if any, between non-motor symptoms with that of the severity of Parkinson‟s Disease in accordance with the stages 1 to 5 of the Modified Hoehn and Yahr Scale. Materials and method: This present study was Cross-sectional type of observational study. This study was conducted from April 2021 to October 2022of Patna Medical College and Hospital, Patna. Total 50 patients were included in this study. Result: Majority of the patients (58%), suffer from depression, followed by dementia (30%), followed by hallucination/illusion/ delusion (24%), followed by panic attacks (18%).Percentage of depression was found to be highest in Stage 4 with 71.4% (5 out of 7), followed by Stage 5 (66.67%), Stage 2.5 (57.14%), stage 3 (54.54%), stage 2 stage 1.5 (40%) and stage 1 with (28.57%).The percentage of patients with RBD was highest in Stage 1.5 with 60% (3 out of 5), followed by Stage 3 (45.45), stage 5 (33.33%) and stage 2.5 (28.57%) followed by stage 1 (14.28%) and 4 (14.28%).The percentage of patients with RLS was highest in Stage 2 with 40% (4 out of 10), followed by Stage 5 with 33.3%.The percentage of patients with EDS was highest in Stage 1.5 with 100%, followed by Stage 5 with 66.7%.The percentage of patients with Nocturia was highest in Stage 5 with 100%, followed by Stage 3 with 72.7%. Conclusion: This study helps in screening patients with Parkinson‟s disease (PD) of non- motor symptoms (NMS) and aims at providing holistic treatment improving the quality of life. There is a need for large and well-designed prospective, adequately powered, large community-based study on the prevalence, the symptom, the efficacy of treatment, and the progression over time, of NMS in PD. This will provide a basis for improving the quality of care of these patients by clinicians.

Introduction: Obesity and Type II Diabetes Mellitus are increasing in epidemic proportions worldwide, and both increase the incidence of cardiovascular events. Type II DM has long been recognized as a risk factor for stroke, and its association with all-cause mortality is also widely acknowledged. Aims:To know the relation of Body Mass Index to systemic hypertension, type II diabetes mellitus and dyslipidemia (triglyceride, total cholesterol, HDL cholesterol and LDL cholesterol Materials and Methods: Either in patients or out patients of systemic hypertension, type II diabetes mellitus or dyslipidemia coming to Patna Medical College and Hospital, Patna. During the period April 2021 to October 2022.110 Patients were included in this study Result: In our study also showed that mean Triglyceride in BMI <25 was 128.56, in BMI 25 – 29.9 was 140.08 and in BMI >30was 175.67. Mean TG was increases with the increase of BMI. Mean HDL in BMI <25 was 58.80, in BMI 25 – 29.9 was 52.71 and in BMI >30was 44.17. Mean HDL was decreases with the increase of BMI. Mean LDL in BMI <25 was 107.87, in BMI 25 – 29.9 was 122.00 and in BMI >30was 153.83. Mean LDL was increases with the increase of BMI. Mean Total Cholesterol (TC) in BMI <25 was 186.31, in BMI 25 – 29.9 was 200.53 and in BMI >30was 231.67. Mean TC was increases with the increase of BMI. Conclusion: Present study highlights the implication of BMI in day-to-day clinical practice in detecting the patients with high chronic diseases risk like hypertension, diabetes, and dyslipidaemia

Introduction: Type 2 Diabetes mellitus is the most common metabolic disorder in India. It is assuming epidemic proportions with the Asian-Indian phenotype being more susceptible for the development of the disease. Among Indians, the onset of type 2 diabetes occurs at a younger age making them more vulnerable to develop all the complications of diabetes due to longer duration of the disease. Aims: To study the utility of serum Cystatin C as a marker for early detection of renal dysfunction in type 2 Diabetes Mellitus. Materials and Methods: The study included 50 diabetic patients admitted to/ treated on outpatient basis at the Patna Medical College and Hospitals, Patna during the study period extending from May 2021- April 2023. Result: Glycemic control was assessed by HbA1c. 14 patients (28%) had HbA1c <7% indicating adequate control and 36 (82%) had poorly controlled sugars and 41 patients (82%) all of whom had normal serum creatinine values were found to have 24 hr urine creatinine clearance < 90 mL/min indicating renal dysfunction. Conclusion: Serum Cystatin C appears to hold promise in predicting early renal dysfunction and more so as an indicator of overt nephropathy. The equation of Rule et al seemed to perform better than Grubb’s equation in our study population in estimating GFR.

Introduction: Diabetes mellitus is a metabolic disorder with multiple contributing components, including a fundamental impairment in carbohydrate metabolism, defects in lipid and protein metabolism, and the modulation of these metabolic processes by HLA, environmental factors, and genetics. It tends to be hereditary. Caused by a decline in Insulin synthesis or use, it leads to improper nutrition uptake and metabolic dysfunction. Several variables, both environmental and genetic, contribute to the development and progression of diabetes. Certain risk factors, such as- Age, Positive F/H, Obesity, Physical inactivity and Resistance to Insulin. Aims: To assess the Prevalence of Left ventricular diastolic dysfunction (LVDD) in patients of type 2 diabetes mellitus with a minimum period of 5 years and the correlation of Left ventricular diastolic dysfunction and glycosylated hemoglobin ( HbA1C) Materials and Methods: It is a Cross Sectional Study of patients with Type 2 diabetes with minimum of five years duration of disease was evaluated for Doppler echocardiography and Glycosylated hemoglobin levels who were admitted in the medical ward of Katihar Medical College, Katihar, since December 2020 to May 2022. Result: In my study population out of 100 patients, 53% of patients were found with Left Ventricular Diastolic Dysfunction, and 47% of were normal seen with Left Ventricular Diastolic Dysfunction and present study determined association of left ventricular diastolic dysfunction (LVDD) with HbA1c in type-2 diabetes mellitus patients. Conclusion: As level of HbA1c is increases in a patient, the chances of developing Left ventricular diastolic dysfunction is also increased and As the FBS & PPBS is increases in a patient, the chances of developing Left ventricular diastolic dysfunction is also increased.

Many attempts have been made to attenuate the pressor response to laryngoscopy and endotracheal intubation e.g. deep anaesthesia, topical anaesthesia, use of ganglionic blockers, antihypertensive agents, calcium-channel blockers, fentanyl, lignocaine, magnesium sulphate etc.  Clonidine is mainly used as an anti-hypertensive agent, but has many properties of ideal premedicant and also has beneficial effects on haemodynamics during stressful conditions like laryngoscopy and endotracheal intubation. Different studies have shown that intravenous clonidine is effective in reducing the haemodynamic responses to laryngoscopy and endotracheal intubation on an average dose of 3-4µg/kg body weight. The present study is aimed to observe whether further reduction in dose of clonidine will be effective or not for the same. This study was designed to observe the effects of clonidine hydrochloride infusion on haemodynamic response to laryngoscopy and endotracheal intubation during general anaesthesia in comparison with placebo and to observe any side effect of the study drug. Methods: In this prospective randomized study two groups of 34 patients each were studied. The Group-A received normal saline as study solution and Group-B received 2μg/kg Clonidine as study solution, was infused with an infusion pump over 10 minutes as per randomization table. After completion of infusion General Anaesthesia was administered and haemodynamic variables were noted immediately, one, three and five minutes after intubation. There was rise in all the parameters (HR, SBP, DBP, and MAP) compared to baseline value in both the groups. Inter-group comparison was done with respect to all the above parameters and side effects in both groups were noted. Result: There was rise in mean heart rate which was statistically significant at immediately after LETI compared to baseline within the groups, but the rise was not statistically significant when compared between two groups. Inter-group comparison shows that there was statistically significant lower rise in the study group. Immediately and one minute after LETI the difference in mean systolic blood pressure from baseline was statistically significant but at three and five minute the rise was similar in both the groups. Inter- group comparison shows highly significant difference in rise of diastolic blood pressure between two groups. Mean arterial pressure showed statistically significant rise from baseline at all the point of measurement after LETI in both the group. This rise was significantly less in study group only immediately after LETI. Inter-group comparison at other points of measurement  showed no difference in changes of mean arterial pressure between the groups. Conclusion:  We conclude that pre-induction low dose Clonidine infusion is a reasonable option to attenuate haemodynamic surge following LETI compared to placebo.

Introduction: Diabetes mellitus (DM) is one of the main problems in health systems and a global public health threat that has increased dramatically over the past 2 decades. Aims: To determine the effects of ulcer size, ulcer age, duration of diabetes, glycaemic control, infection, lower limb ischemia and neuropathy on outcome of diabetic foot ulcer. Materials and Methods: The present study was a Prospective comparative study. This Study was conducted from December 2020 to May 2022 at Department of general Surgery, Katihar medical college and Hospital, katihar. Result: Regarding the duration of diabetes, their findings indicate that individuals with longer duration of diabetes were at higher risk of developing foot ulcers. Specifically, individuals with diabetes for more than 10 years had a higher prevalence of foot ulcers compared to those with diabetes for less than 10 years. This is consistent with your study's finding that the mean duration of diabetes in individuals with foot ulcers was 9.21±3.76 years. Conclusion: The study results suggest that a conservative approach may be a more cost- effective option for treating diabetic foot ulcers, and early diagnosis and treatment can lead to better outcomes. Further research could focus on developing more targeted and effective treatments for foot ulcers, as well as improving prevention measures for diabetic complications. In this study suggests that with targeted approach we have almost obviated the need for any amputation.

Introduction: Cerebrovascular accident (CVA) or stroke is defined as an abrupt onset of a neurologic deficit that is attributable to a focal vascular cause. 1Cerebrovascular accidents (CVA) can be classified into two major categories: about 87% of strokes are ischemic, the rest being haemorrhagic. It is difficult to be sure clinically about the type of stroke (haemorrhagic or ischemic) in majority of cases as there is no absolute differentiating feature. Aim:Monitoring ECG changes in real time can help lessen the severity of the consequences of a cardiovascular event and the number of casualties.  Materials and Methods: The present study was a hospital based prospective observational study. This Study was conducted from December 2020 to May 2022 at Departmentof General Medicine, Katihar Medical College, Katihar. Result:In this study, ST segment changes, T wave changes, U waves, Q waves, LVH, Sinus arrhythmia, P Pulmonale, Normal were significantly associated with type of stroke. Conclusion:Patients with cerebrovascular accidents often have abnormal electrocardiogram in the absence of known organic heart disease or electrolyte imbalance. These ECG changes are more common in intracerebral hemorrhage and subarachnoid hemorrhage than in infarcts.

Background: Mental retardation is a serious and lifelong disability that places heavy demands on society and health system. Since the first publication on this topic, the prevalence of mental retardation has been thoroughly studied for different purposes in different parts of the country as well as different parts of the World. Consanguinity marriage of parent as an apparent etiological factors of mental retardation Method: This is descriptive study with the 100 consecutive samplings in a tertiary centre where the diagnosis of mental retardation was made based on Malian’s Intelligence Scale for Indian Children validated by the Department of psychiatry, Silchar Medical College and were evaluated for socio-demographic profile of the parents.the study was done after clearance from institute ethical committee. Statistical Analysis Used: Statistical package for the social sciences (SPSS) version 19. Chi square test was used and p value of less than 0.05 was taken as statistically significant. Result.  Correlating mental retardation with consanguinity of marriage of the parents we find that most of the parents are consanguineous marriage (72%) and all the 3 cases of profoundly retarded child also coming from consanguineous marriage group (P=0.0269) Conclusion: Though the results are different in different studies it definitely appears that consanguinity is strongly associated with mental retardation of the children. Statistically not significant is found in our present study.

Introduction: Stroke is characterized by neurological deficits of vascular origin. Its incidence has increased in low-to-middle income countries but decreased in high-income countries, while the severity has remained stable. Risk factors for stroke can be non-modifiable (e.g., gender, race, family history) or modifiable (e.g., lifestyle, medical interventions). Non-modifiable factors cannot be changed, while modifiable factors can be modified through lifestyle changes and medical treatment. Method: This cross-sectional study was conducted at Shyam Shah Medical College, Rewa, involving 154 cases of cerebrovascular accidents (CVAs). Informed consent was obtained from the patients or their close relatives prior to participation in the study. Results: The highest number of cases in our study was observed in the age group of 61-70. prevalence of various risk factors in the study population. Diabetes was found to be present in 44.15% of the participants, hypertension in 20.77%, tobacco chewing in 34.41%, smoking in 41.55%, and alcohol consumption in 40.91%. 54 cases (35.06%) were in the lower socioeconomic class, 38 cases (24.67%) were in the upper-lower socioeconomic class, and 62 cases (40.27%) were in the upper, upper middle, and lower middle socioeconomic classes. that total cholesterol in the cases was 186.91±36.15. Similarly, there were significant elevations in Triglyceride (TG) levels and Low-Density Lipoprotein (LDL) in study group. Conclusion: By managing diabetes and hypertension, quitting tobacco and smoking, and reducing alcohol intake, we can reduce stroke prevalence and improve health outcomes. Collaboration with healthcare professionals is essential for personalized risk factor modification.

Introduction: Perioperative patient safety remains crucial in healthcare to prevent avoidable errors. The World Health Organization developed a surgical safety checklist that was implemented by the Department of Health as well as highly recommended by quality Programmes. Aim: To document the level of knowledge and practices regarding WHO recommended Surgical Safety Checklist among the Surgeons and other OT staffs. Materials and Methods: A cross-sectional study was conducted among the Operating surgeons, OT Nurses, Anesthesiologists working at HIMS. They were contacted personally to fill pre - tested Knowledge attitude and practice testing questionnaire. Approval was taken from the institutional ethical committee. Before conducting knowledge assessment a checklist was used to study the completeness of the filled surgical safety checklist form from the case sheets Results: 57% of the respondents had more than 10 years of experience. 81% were permanent employees of the institution. 66% participants had attended trainings related to the checklist. Majority mentioned their source of information about checklist was training and as well as after it was introduced in the OT booklet. Questions related to Sign in, Time out and Sign out phases were correctly answered by 28.5%, 28.5% and 38% of the participants respectively. Majority had partial knowledge (>70%) regarding the three phases. 72 % of the case sheets were complete at Medical Record Department compared to 58% at immediate post op ward. Barriers mentioned by the participants are that the time was inadequate and filling checklist was an added responsibility, number of OT staffs were inadequate, to bring the OT room to completely stand still when the checklist is read out is difficult especially to junior surgeons. Few mentioned they needed training and also one mentioned that signing the checklist each time is itself a barrier. Conclusion: The results of this study indicate that the overall application of the surgical safety checklist can be considered high, although the completeness, especially of the time out and sign out section, could be improved. Variation in use of the checklist is noted between Departments and Units. It requires training and awareness activities across the Departments.

Introduction: PONV is defined as nausea and/or vomiting occurring within 24 h after surgery. Post-operative nausea and vomiting (PONV) is a common and distressing complication after anaesthesia and surgery, with an incidence of approximately 30%. PONV is usually self-limiting and nonfatal but it is unpleasant and leads to considerable post-operative discomfort and dissatisfaction. Objectives: Efficacy of dextrose infusion before induction to prevent post-operative nausea vomiting and whether it is influenced by plasma osmolarity.  Materials and Methods: The present study was a prospective randomized double blinded clinical study. This Study was conducted from January 2019 to January 2020 at Department of Anaesthesiology, Bankura Sammilani Medical College and Hospital, Bankura, West Bengal. Result: Rapid infusion of 5%Dextrose may increase the blood sugar level to an unexpected level which was our concerned. But after completion of the study we found negligible amount of patients (13.3% at immediate post-operative period, 5.3% at 1st hour post-operative period, 2.6% at 2nd hour post-operative period) in Group D had capillary blood glucose level more than 180mg/dl which is the upper limit of target blood sugar level perioperatively.  Conclusion: From our study it was found that intra venous administration of Dextrose (5%) before induction of patient’s undergone laparoscopic cholecystectomy can reduce post-operative nausea and vomiting (PONV) significantly and even if PONV occurred the quantity of rescue antiemetic combat PONV also reduced significantly.

Background: NSTE-ACS with significant left main coronary artery (LMCA) disease or its equivalent needs early revascularization in where a significant number of cases CABG may be the treatment of choice. Anticipating LMCA disease or its equivalent may help in proper planning of revascularization. This study was carried out to find out clinical, electrocardiographic and echocardiographic predictors of LMCA disease in high-risk patients with a first episode of NSTE-ACS and also to find out the incidence of LMCA disease among those patients.  Results: In this hospital based observational study 300 patients admitted with 1st episode of NSTE-ACS and classified as very high and high-risk category according to 2015 ESC guideline, were evaluated in respect to clinical, biochemical, ECG and echocardiographic parameters. Later coronary angiography was done. Overall LMCA disease patients were more symptomatic and severely ill but not statistically different from TVD patients. ST elevation in aVR ≥1mm had more specificity but less sensitivity in predicting LMCA disease. ST elevation in both aVR and V1 (ST elevation in aVR ≥ V1) and ST elevation in aVR + ST depression in I, II, V4-6 were other significant ECG predictors of LMCA disease. Incidence of NSVT/VT and high grade of diastolic dysfunction were significantly high among LMCA disease patients. None of the clinical or biochemical parameters could be established as predictor of LMCA disease. Incidence of overweight, central obesity, persistent chest pain, severe shortness of breath, severe heart failure, high total cholesterol, high LDL, low left ventricular ejection fraction and very low left ventricular global longitudinal strain were high among LMCA disease. But there was no statistically significant difference between LMCA disease and TVD with respect to any of these parameters. All of these parameters are significantly better in non LMCA/TVD group and could differentiate LMCA/TVD cases from non LMCA/TVD patients with statistical significance. Conclusion: Though any of these parameters couldn’t predict LMCA disease but these parameters could suggest severe form of coronary artery disease; i.e., either LMCA disease or triple vessel disease which might need urgent CABG.

Introduction: Lymphadenopathy is defined as an abnormality in the size or character of the lymph node. It is caused by invasion or propagation of either inflammatory cells or neoplastic cells into the node. Cervical lymphadenopathy may be the sole clinical finding or may coexist with other non-specific findings and recognition of enlarged cervical lymphnodes will often unveil a spectrum of differential diagnosis. Aims: To evaluate sonographic features in cervical lymphadenopathy under different parameters, distribution of etiologies according to sonological parameters and sensitivity and specificity of different sonographic parameters in differentiating benign from malignant lymphadenopathy. Materials and Methods: The present study was an observational study with prospective component. This study was conducted for 18 months at department of Radiology, Murshidabad Medical College and Hospital, Berhampore, West Bengal. Result: In the present study among malignant nodes 44% showed peripheral vascularity and 56% showed mixed pattern of vascularity. Echogenic hilum showed  89% and 77% sensitivity and specificity in differentiating malignant nodes with PPV and NPV of 44% and 97% respectively.. Conclusion: Different sonographic parameters have high sensitivity and specificity in differentiating malignant from benign nodes

: The aim of this study was to assess lipid profile among malaria-infected patients Material & Methods: An Observational Study on 168 patients in the Department of General Medicine, NMCH, Sasaram in between March 2021 to September 2022. Lab reports of malaria patients were obtained. Patient’s baseline demographic and clinical characteristics were recorded in a structured proforma. Estimations of malaria parasites based on thick and thin smear for parasite (PSMP) & RCT for MP was done. Blood samples were taken for estimation of lipid profile in addition to routine laboratory investigations. Lipid profile test was be done by ERBA EM-200 analyzer. Results: This study was concluded on 168 laboratory- confirmed cases of malaria patients of P. vivax (84) and Mixed malaria- P. falciparum+ P. vivax (84). There were 168 healthy volunteers taken as the control group. The mean ages of patients in P. vivax group were 26.20±13.80, Mixed Malaria group was 34.82±12.50, and the control group was 38.00±9.70 respectively. The sex distribution among cases & control (males-80% and females 20%). for total cholesterol, HDL and LDL were significantly lower in case group 95.21±22.24 mg/dl, 13.24±7.01 mg/dl and 64.85±16.50 mg/dl respectively than in control group of 182.73±17.14         mg/dl,         44.11±7.30,         and 112.38±17.37 mg/dl respectively (p <0.05). But, serum triglyceride and VLDL were significantly higher in case group 146.78±38.59 mg/dl and 29.35±7.27 mg/dl respectively than in control group 132.40±15.51 mg/dl and 24.68±3.68 mg/dl respectively (p <0.05). Conclusion: In conclusion, the characteristic pattern of derangements in lipid profile in malaria patients. Malaria parasites, both P. vivax and P. falciparum infections, cause derangements in lipid profile that are characterised by low serum total cholesterol, low HDL, low LDL and high triglyceride levels. The decrease in some of the lipids might lead to the onset of severe malarial infection

Introduction: Lactate dehydrogenase (LDH) is the enzyme which catalyzes the reversible conversion of locate to pyruvate. Since the reaction is an integral part of glycolytic pathway of carbohydrates metabolism, LDH is present in virtually all body tissues. There is increasing evidence that Endothelial cells and altered endothelial cells function to play an important role in the Pathogenesis of preeclampsia. Aims: To determine the relationship between serum concentrations of LDH and pre- eclampsia severity and LDH level in 3rd trimester of pregnancy with preeclampsia. Materials and Methods: The present study was a Observational Analytical Study. This Study was conducted from May 2021 to April 2022 at The study has done by Dept. of Biochemistry in collaboration with Department of Obstetrics and Gynecology, Burdwan Medical College and Hospital. Result:  We showed that, mean LDH was significantly higher in Case Group [526.4451± 66.8891 (IU/L)] compared to Control Group [236.1830± 24.1872 (IU/L)] (p<0.0001) and Weight was slightly higher in Control Group [61.8595± 4.5723 (Kg)] compared to [61.4261± 4.7520 (Kg)] Case Group but this was not statistically significant (p=0.4170). Conclusion: We showed that, mean LDH (IU/L) was significantly higher in Case Group compared to Control Group.

Introduction: Scrotum is a fibro muscular cutaneous bag containing testes, the epidydimis and the part of the spermatic cord with associated facial coverings. These structures are affected by various types of pathological conditions which may be congenital, inflammatory and neoplastic conditions.  Aims: Role of high resolution ultrasonography and colour Doppler study in scrotal lesions to characterise and classify the different types of scrotal lesions. Material and methods: The present study was an Observational descriptive study. This Study was conducted from April 2021 to September, 2022. At Department of radio diagnosis and department of surgery, IPGMER and SSKM hospital, Kolkata. Results: In most of the cases vascularity on Doppler was absent (58.0%) which was significantly higher than presence of vascularity (42.0%) (Z=2.23; p=0.023). Increased vascurality (34.0%) was found be significantly higher (Z=4.51; p<0.0001). Conclusion: High-resolution sonography, along with colour Doppler flow imaging serves as an excellent diagnostic imaging modality in the evaluation of scrotal pathologies. Colour Doppler Flow Imaging and Power Doppler add useful information and complement to gray-scale sonography in reaching a correct diagnosis thus guiding further management.

Background: Diastolic dysfunction in young adults is associated with increased morbidity and mortality. The identification of prospective risk markers associated with diastolic dysfunction could allow for targeted primary prevention efforts. We try to establish the correlation between the fatty liver with diastolic dysfunction in normotensive young patients under 40 years of age. Method: This cross-sectional analytical study was conducted between April 2021 and March 2022 in Sanjay Gandhi Memorial Hospital associated with Shyam Shah Medical College, Rewa. It included 214 normotensive cases under 40 years with fatty liver. Patient information, clinical examination, and various tests were conducted to assess diastolic dysfunction. The collected data was compared with previous studies for analysis. Results: Out of 214 cases 105 (49%) were male and 109 were female (51%). Mean age of the patients was 27.84 ± 8.27 years. Out of 214 patient’s normal diastolic dysfunction found in 167 (78.04%) cases followed by the 26 (12.15%) cases had grade- 1, 15 (7.0%) cases had grade 2 and 06 (2.81%) patients had grade 3 diastolic dysfunction.  Among all cases 180 (84.11%) of the patients had grade 1 fatty liver out of which 156 (86.66%) had no diastolic dysfunction, while the 17 (9.44%) cases had grade- 1, 6 (3.33%) had grade 2, and 1 (0.55%) patient had grade 3 diastolic dysfunction. 29 (13.55%) cases were found to have grade 2 fatty liver out of which 6 (20.68%) had no diastolic dysfunction, while the 9 (31.03%) cases had grade- 1, 9 (31.03%) had grade 2, and 5 (17.25%) patients had grade 3 diastolic dysfunction. 5 (2.33%) cases found to have grade 3 fatty liver all 5 (2.33%) were found to have no diastolic dysfunction.  Conclusion: The prevalence of diastolic abnormalities in adults under 40 years with fatty liver was 21.9%, indicating a significant correlation. Clinicians should consider cardiovascular risks and undertake early risk factor modification.

Background: Placental location can be estimated easily using ultrasonogram by 16 weeks. It can be classified based on its location into central and lateral. Central can be anterior or posterior. Lateral can be left lateral or right lateral. Placental location has been attributed to both normal and abnormal pregnancy and neonatal outcomes. Methods: this is a hospital based observational study was conducted in the Department of Obstetrics and Gynaecology, Gandhi Medical College,Bhopal. After approval from institutional ethical committee for a period of 18 months from January 2021 to June 2022. Primigravida patient admitted at Department of Obstetrics and Gynaecology, Gandhi Medical College, Bhopal will be included with consideration of inclusion and exclusion criteria.  Results: 56.1% of the 540 participants were 18–24 years old. 61.5% were rural residents, , and the mean age was 24.63 years with a standard deviation of 4.79. 182 (33%) and 66.3% study participants were booked.The Modified Kuppuswamy scale classified 53.7% of the 540 participants as lower socioeconomic class. Majority of the study participants had fundal placental location(41.9%), most of Preterm labour and PROM associated with fundal and lateral placenta(30.8%), In this study, majority of participants with anterior placenta had 4.7% had Puerperal sepsis, 34.8% had retained placenta and 34.6% had PPH. Anterior placental location had statistical significant association with Retained placenta. Among foetal complications, 5.6% of babies had depressed Apgar at 1 min and 4.7 % of babies had depressed Apgar at 5min mostly associated with anterior placenta(33.3%) and (40%) and required NICU admission. Among 0.95% neonatal deaths mostly 60% neonatal deaths because of ARDS which is associated with posterior placenta location (66.7%). Conclusions: There is a significant association between abnormal placentation and abnormal pregnancy and neonatal outcomes. Second trimester ultrasound can be used as non-invasive predictor of adverse pregnancy and neonatal outcomes.

Introduction: Cesarean delivery is defined as the birth of a fetus through an incision on the abdomen and uterus. Uterine dehiscence generally refers to an incomplete, and frequently a clinically occult, uterine scar separation where the serosa remains intact. This study estimates the incidence of intraoperative finding of scar dehiscence in anemic women undergoing repeat cesarean delivery. Aim: To estimate the incidence of intraoperative finding of scar dehiscence in anemic women undergoing repeat cesarean delivery. Materials and Methods: Data taken from the records for the past 5 years in the parturition register maintained in the labor room of our institution. Study design: Retrospective study. Sample size: All women who underwent repeat cesarean delivery in the past 5 years. Results: In the study 81.5% had 1 previous LSCS, 18.1% had 2 previous LSCS and 0.4% had 3 previous LSCS. 72.2% had no anemia. 12.3% had mild, 13.7% had moderate and 1.8% had severe anemia. Among subjects without anemia, 33.2% had scar dehiscence, among subjects with mild anemia 46.4% had scar dehiscence, among subjects with moderate anemia 72.6% had scar dehiscence and among subjects with severe anemia 87.5% had scar dehiscence. Anemic subjects had 3.26 times higher incidence for scar dehiscence compared to non-anaemic subjects intraoperatively. With increase in severity of anemia there was an increase in incidence of scar dehiscence. Discussion: The rate of Cesarean delivery has considerably increased during the past few decades. Cesarean delivery can lead to many acute and chronic complications and one of them is scar dehiscence. Anemia in pregnancy is a common condition found in the practice of obstetrics. India contributes to about 80% of maternal deaths due to anemia in South Asia. Iron deficiency anemia is the most common form of anemia seen and iron deficiency has been shown to result in impaired collagen synthesis. The impaired collagen synthesis can impair the healing of the uterine scan and lead to complications such as scar dehiscence in subsequent pregnancies. Conclusion: Reduced integrity of the uterine scar may be a consequence of an iron deficient state and timely identification and treatment of anemia in an ongoing pregnancy may be important to improve the integrity of the cesarean scar and in turn reduce the rate of cesarean scar dehiscence.

Background: Anaemia is a medical condition in which the haemoglobin (Hb) concentration and erythrocyte count are lower than the normal range. The main causes of anaemia are a decrease in RBCs, insufficient Hb synthesis or increased RBCs destruction, and the primary cause is an iron deficiency. A useful method for diagnosis and classification of anaemias is based on the morphological appearance of RBCs on an ideal stained blood smear. Aim: In our prospective study we investigated about the morphological type and the etiological spectrum of anemia  Materials and Methods: A hospital based prospective was carried out in the Department of Pathology, tertiary care hospital, central India from October 2021 to September 2022. A total of 250 patients of 18-80 years age group were evaluated for morphological pattern of anaemia based on red cell indices, peripheral smear, and leukocyte and platelet parameters. Anaemia was defined according to WHO criteria as Hb concentration <13 g/dL in men and 12 g/dL in women.  Results: The results of CBC and PBP showed that 72 (29%), 138 (55%), and 40 (16%) of the patients had normocytic normochromic, microcytic hypochromic and macrocytic pattern of anaemia respectively. The gender wise classification of the patterns revealed that 44 male patients and 28 female patients had normocytic normochromic patterns, while 105 female patients and 33 male patients had microcytic hypochromic patterns whereas 23 males’ patients and 17 cases of female patients showed macrocytic pattern. Pancytopenia was found in 12% cases while neutrophilia and lymphocytosis were in 10% cases. Conclusion: Morphological patterns of anemia reflect the underlying etiology, the study of which would ensure benefits in the early detection and appropriate treatment. Iron deficiency anemia being a nutritional anemia which can be prevented by improving nutritional status, creating awareness and educating people.

Background In this study, we wanted to evaluate the surgical management of peptic perforation and compare between simple closure and definitive surgery.  Methods This was a hospital based comparative study conducted among 154 patients who presented with peptic perforations to the Department of Surgery, Heritage Institute of Medical Sciences, Uttar Pradesh, from March 2020 to February 2021, after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants.  Results The highest incidence was recorded in poor socio-economic status. There was no previous history of peptic ulcer. 91 % of the patients were operated within 72 hours of perforation. The commonest form of presentation was pain abdomen, which was present in all the patients. Gas under the diaphragm was present in 86 % of cases. Gastrografin study was done in some of patients to facilitate diagnosis. Bilious fluid came out in four quadrants peritoneal tap. 67.5 % of the perforations were less than 5 mm in size and 96 % of perforations were less than 10 mm in size. Out of 154 cases, 52 patients (34 %) had post-operative complications. In group -A, mortality was 11.5 % and 7 % in Group - B. Average hospital stay in Group - A was 11.73 days and average hospital stay in group B was 13.05 days. Dyspepsia occurred in 58.4 % of patients; hematemesis and/Melena in 15 (9 %) cases, pyloric stenosis in 4 (2.6 %) cases and re-perforation in 2 (1.7 %) cases in two years of follow up. Ulcer recurrence occurred in 30.5 % of patients and was treated by simple closure in 2 years of follow up; but there was no recurrence in patients treated by definitive surgery during this period.  Conclusion Simple closure of the perforation with drainage of peritoneal cavity is safe for those in whom definitive surgery is relatively contraindicated like, elderly patients presenting with moderate to severe shock, after 48 hours of perforation and with concomitant medical illness. Therefore, painstaking efforts are made in selecting proper cases for definitive surgery, so that both immediate and long term good result can be obtained.

Introduction: Cystic echinococcus is a chronic, neglected zoonotic disease with worldwide distribution, caused by the larval form of echinococcusgranulosus in human being. Its clinical spectrum ranges from asymptomatic infection to severely potentially fatal diseases. The aim of present study was to evaluate the histopathological spectrum of hydatid cyst involving various organs of the body with their demographic pattern in our tertiary care hospital.Material and method: A total of 4757 specimens after surgical resection, attending different OPDs as well as from indoor patients, were received to our pathology department for histopathological examination.Results: Out of 4757 specimens received for biopsy; 12 cases werediagnosed as Hydatid cyst. Out of which, 66.67%cases were male and 33.33% cases female. The disease was found in both the religions, Hindusas well as Muslims.66.67 % cases were of less than 40 years of age; and the youngest patient in this series was 12 years old male child.Conclusion: FineNeedle aspiration Cytology (FNAC) has a very limited value in diagnosis of hydatid disease and the use of FNAC in diagnosis of hydatid disease is still controversial and generally not recommended due to potential risk of precipitating acute anaphylaxis. Serological tests as well as Imaging modalities, like X-Ray, ultrasound, CT scan and MRI scan, play an important role in diagnosis of hydatid cyst. Surgery remains the primary choice of treatment of hydatid cyst and final diagnosis by histopathological examination.

Background Pharmacovigilance involves early detection of adverse drug reactions (ADRs) for safe use of drugs.This study assessed the awareness of ADR and its reporting among first year medical students, and the impact of sensitization program on their awareness at a tertiary care teaching hospital in Navi Mumbai.  Methodology In this cross-sectional study, we collected responses from a total of 202 first professional MBBS students using a 10-item self-reported questionnaire. The questionnaire included closed ended items validated before use. Afterpre-test, a 45-minute sensitization session on ADR reporting and pharmacovigilance was conducted. Post-testwith same questionnaire was held after the session. Absolute change in percentage of correct responses and improvement in the scores on three-point scale (improved, no change, decline) were assessed based on the change in the percentage score from pre-test to post-test assessment. Results Complete data available for 118 studentswere analyzed. The percentage of correct responses increased from 76.55% (pre-test) to 81.39% (post-test) after the sensitization session for (n=118). Thus, mean absolute scores improved significantly (4.84% improvement; p=0.003). Greatimprovements (% responders) was seen for the item (1) Are there separate ADR reporting forms for doctors and patients (46.6%)Improvement in scores was observed in 94 (79.7%), no change(1.7%), decline (18.6%). Conclusion Awareness about ADR and its reporting was considerable amongst medical students, and sensitization session further improved the awareness.Early sensitization andfrequent short sessions are needed to improve ADR reporting among health care workers and professionals.

Introduction: Asthma is a major public health problem that negatively impacts patients, their families, and the community by inducing work and school loss, a poor quality of life, frequent emergency visits, hospitalizations, and death. A Consistent increase in asthma over past 60 yrs. has made it an extraordinary common disease The prevalence of asthma is very high in children of North India and Punjab region due to Urbanisation, air pollution, environmental factors and genetic factors. Montelukast is now potent drug approved for use in persistent asthma and also as preferable over ICS in some cases. Aims: To assess and compare the efficacy and safety of Budesonide (inhalational corticosteroid) and Montelukast (oral leukotriene-receptor antagonist) in children with Mild-moderate persistent asthma. Material and Methods: A Cross-Sectional study was done on 80 children, 40 in each group, who visits Paediatric Department of Rajindra Hospital, Patiala with mild to moderate persistent asthma after taking informed consent from patient’s guardian and Ethical Committee of GMC Patiala. The efficacy was assessed by wheezing/asthma exacerbation, pulmonary function (forced expiratory volume in 1 second), reduction in night symptom score or beta agonist use. The safety was assessed carefully by patient reported side effects. Results: The Percentage change of Mean FEV1 values from Baseline to Post- Therapy in Group-1 was 23.367% (p-value-0.001) and Group-2 was 27.097% (p-value-0.001). Change in Mean FEV1 Values in both the groups in individual was Highly significant but when compared to one another, had insignificant difference. Conclusion: There was a significant improvement in the within group analysis in FEV1 in both Montelukast and in the Budesonide group over the period of 1 year. Both the drugs are Safe to use except for few non-significant side-effects which are Manageable.

Introduction: The COVID-19 pandemic had a significant impact on a large portion of the global population. During the initial phase of the pandemic, there was limited knowledge on how to prevent the spread of the infection. Social distancing and lockdown measures were identified as effective strategies to curb the transmission of COVID-19 infections. The objective of the survey was to evaluate the knowledge and awareness of COVID-19 infection among suburban populations. Methods: An online survey was conducted among the adult population residing in a suburban city in India. The survey included questions about socio-demographic details, common signs and symptoms, modes of transmission of COVID-19, as well as the impact of the lockdown on their daily routines, concerns, and economic effects. Results: The survey received a substantial response from participants, with 738 adults taking part, and data from 696 individuals was included in the analysis. Of the participants, 77% were male and 23% were female. It was found that 67% of the survey participants were aware of the symptoms of COVID-19. Additionally, during the lockdown, 88% of the participants reported spending their time watching TV, using mobile devices, and engaging in household work. Conclusion: The majority of the population was aware of the common signs and symptoms of COVID-19 and how it spreads. Additionally, the lockdown period had an impact on the sleep patterns of approximately half of the individuals surveyed.

Aim: The study was conducted to determine incidence, causes and management of small bowel obstruction following appendectomy. Methods: This was a prospective, observational study conducted at Government Medical College, Srinagar, India from June 2018 to October 2020.The study group consisted of 250 patients who underwent emergency appendectomy for acute appendicitis. Results: Amongst the study group of 250 patients, 14 (5.6%) developed intestinal obstruction post appendectomy. The frequency of readmission of patients was 1.29 times. Majority of these patients required surgical intervention for management, which led to an increase in morbidity among them. Conclusion: The risk factors for developing small bowel obstruction were reviewed and measures to avoid them were suggested.

Introduction: Urethral trauma as a consequence of high velocity road traffic accidents is a very devastating injury to sustain. This injury leads to distraction of prostatic urethra which is usually acutely managed by suprapubic cystostomy and then by the urethroplasty (progressive perineal urethroplasty) after 3 months. We have recently started this procedure in our department and we conducted the retrospective analysis of the patients who underwent this type of urethroplasty over a period of 4 years.  Aim: The aim of this study is to present our data of a newly started urethroplasty procedure with respect to the success rate and the complications.  Methods: This retrospective study was done in the Post Graduate Department of Surgery Government Medical College Srinagar from January 2019 to December 2022. All patients who underwent progressive perineal urethroplasty during this time period were included in this study and their preoperative, intraoperative and postoperative data and follow up was studied. All the procedures were done by a single surgeon.  Results: A total of 24 patients were operated on. The mean age of patients was 24.8 years and the mean interval between injury and urethroplasty was 9.7 months. Single ramus fracture 54.17% was the commonest type of fracture. Mean length of the stricture was 1.8 cm and we achieved a success of 91.66% in our series of patients.  Conclusion: Progressive perineal urethroplasty can be performed with excellent results if the surgeon is well trained in other urethroplasty procedures.

Introduction: Hypothyroid or Hyperthyroid state affects all the physiological systems including cardiovascular system, central nervous system, digestive system, blood, etc.  Despite increasing knowledge of thyroid physiology and better means for investigation of thyroid functions, we still are at preliminary stage of understanding the pathophysiology of these disorders Objectives: The present study was carried out to compare body T3, T4 and TSH levels in newly diagnosed patients of hypothyroidism, hyperthyroidism and age and gender matched euthyroid subjects Materials and methods: The present study was carried out in 90 female subjects in the age group of 30 to 45. Diagnosis of hypothyroidism and hyperthyroidism was based on both clinical and biochemical criteria. Subjects were divided in euthyroid, hypothyroid and hyperthyroid groups with each group containing 30 subjects. T3, T4 & TSH levels were measured in all the groups. Results: Hyperthyroid group had significantly higher T3 and T4 levels as compared to  euthyroid and hypothyroid groups. Hypothyroid group had significantly higher TSH as  compared to euthyroid and hyperthyroid groups. Conclusion: T3 and T4 levels are significantly higher in hyperthyroidism and they are significantly lower in Hypothyroidism as compared to euthyroid premenopausal women. TSH levels are significantly higher in hypothyroid subjects, while TSH levels are significantly lower in hyperthyroid subjects. Regular monitoring of T3, T4 and TSH especially in women is recommended.

Background: Sepsis is an emergency state in response to an infectious process ultimately leading to multiorgan dysfunction and death. There is an urgent need for sepsis detection methods, especially in emergency settings. To fill this gap, monocyte distribution width (MDW) was studied as an early indicator of sepsis. MDW is a routinely reported component of the automated complete blood count (CBC) performed by hematology analyzers. Overwhelming patient load and scarcity of health resources are among the major challenges that are faced in resource-limited settings. Materials and methods: This is an observational prospective, monocentric cohort study to evaluate the possible association of population cell data parameters with ensuing sepsis at the intensive care unit of Tertiary Care Teaching Hospital. Patients were consecutively enrolled whenever hospitalized for suspected infection or sepsis. Clinical characteristics of patients at entry, including demographics (age and gender); vital signs (heart rate, respiratory rate, body temperature, blood pressure), past medical history and other laboratory examinations (white blood cell counts, blood gas analysis, blood biochemistry) were prospectively collected. Result: Exactly 30 patients (33.3% of total cases enrolled in the trial) belonged to the group that survived till the 28th day of hospitalization, among them were 12 women (40%) and 15 men (50%). The rest of the patients from the research, precisely 60 of them, were deceased (66.7%). Among non-survivors were 15 women (25%) and 45 men (75%). Descriptive statistics for selected variables (MDW, age, CRP, PCT, lactate, and ICU days) in certain groups are expressed as mean, standard deviation, minimum and maximum values, and interquartile range. Test of normality (Shapiro–Wilk) for all parameters p < 0.05 showed a nonparametric distribution of data. The Chi-square test was used to compare differences between groups (survived and deceased on the 28th day), with cut-off values for MDW 26.0 μm, CRP 100 mg/mL, PCT 1 ng/mL, lactate 2 mmol/L respectively. Conclusion: MDW is an inexpensive and readily available biomarker that will help emergency clinicians to promptly identify sepsis accurately and start appropriate treatment in a timely manner. MDW as an early sepsis indicator would be a strong addition to current sepsis protocols, especially in resource-limited settings.

Introduction: Cardiopulmonary arrest (CPA) is the cessation of effective ventilation and circulation. It is also known as cardiac arrest or circulatory arrest. In adults, it is most likely to be caused by a primary cardiac event. The most common electrical mechanism which is responsible for 50 to 80% of cardiopulmonary arrest is ventricular fibrillation (VF). While, 20% to 30% which represents the less common causes of dysrhythmias involve Pulseless electrical activity (PEA), and asystole. Pulseless sustained ventricular tachycardia (VT) is a less common mechanism.   Objective:  To study the rate of survival to discharge after in-hospital cardiac arrest and its associated factors in an emergency department of a tertiary care hospital. Materials and Methods: This prospective observational study was conducted in the Department of Cardiology in a Tertiary care Teaching hospital over a period of 6 months among all patients above 18 years old, who suffered witnessed cardiac arrest, after arrival in the emergency department. A semi-structured questionnaire was used to collect data (socio demographic details, chief complaints, comorbidities). Initial documented rhythm, duration of CPR, use of defibrillator, and presumed cause of cardiac arrest and others were collected from the case records. Results: After CPR, 10 (20%) of 50 patients were discharged fully conscious, whereas 40 (80%) patients died; 20 of them died immediately, whereas 20 patients developed hypoxic encephalopathy and died during hospitalization. There was no statistically significant association between age, sex, and associated comorbidities and the outcome of CPR. However, there was a significant inverse relation between the duration of CPR and its outcome. The duration of CPR was significantly lower in survivors (3.80 ±1.90 min) compared with non survivors (11.31 ± 3.41 min) (P<0.001). GCS was significantly higher in survivors group compared with non-survival groups (12.38±0.3 vs 3.68±1.20, P<0.001). Conclusion: These results suggest that out-of-hospital cardiac arrest among children has a very poor prognosis, especially when efforts at resuscitation continue for longer than 20 minutes and require more than two doses of epinephrine.

This study was conducted to compare the efficacy and the best time for administration of ondansetron and dexamethasone in controlling PONV. Methods This was a hospital based prospective study conducted among 120 patients who presented with elective surgeries to the Department of Anaesthesiology and Critical Care, Sri Aurobindo Medical College and Post Graduate Institute, Indore, over a period of one year from September 2015 to September 2016 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results The association between postoperative nausea and vomiting at 1 hour, 2 hours, 3 hours, 4 hours, 5 hours, and 6 hours with groups was found to be highly significant. In comparison of mean VAS at 1 hour, 2 hour, 3 hour, 4 hour, 5 hour, and 6 hour was highly significant, whereas in Tukey pairwise comparisons was found  significant except ondansetron before induction to dexamethasone before extubation, ondansetron before induction to dexamethasone before extubation, Ondansetron before extubation to dexamethasone before induction, ondansetron before induction to dexamethasone before extubation, ondansetron before extubation to dexamethasone before induction, ondansetron before induction to dexamethasone before extubation, ondansetron before extubation to dexamethasone before induction, Ondansetron before induction to dexamethasone before extubation, ondansetron before extubation to dexamethasone before induction, ondansetron before induction to dexamethasone before extubation, ondansetron before extubation to dexamethasone before induction was not significant. Conclusion Dexamethasone administration 20 minutes before induction proved to be the best drug for preventing PONV, especially during the first 6 hours postoperatively.

Imatinib is used in treatment of CML with Philadelphia chromosome positivity. Hepatotoxicity grade1-4 is described in literature. There is a case report of imatinib induced iron overload in a 46 year old male after 8 months of treatment with imatinib which is to our knowledge the only  in this regard. We report case of a 60 year old man who was on treatment for BCR-ABL positive CML for past 10 years now presenting with features of hepatic hemosiderosis. After ruling out known congenital and acquired causes the case can be attributed to Imatinib therapy.

Introduction: A cardiovascular risk prediction model like Framingham Risk Score is being used to estimate10-year mortality risk. Bioimpedance weighing scale gives a better insight to total body fat and visceral fat. It is a useful screening tool to estimate the cardiovascular risk by visualizing fat distribution.  Aim: To determine association of body fat and cardiovascular risk. Materials And Methods: This is a cross-sectional study, conducted on 95patients with BMI of ≥ 23 kg/m2 aged between 30- 60 years visiting to outpatient department. Bioelectrical impedance weighing scale is used to estimate total body fat and visceral fat. Total body fat is correlated with Framingham risk score. Results: The Mean age of patients in study is 45±11 years. Framingham risk score also showed a positive correlation with total body fat (r=0.18) and visceral fat (r=0.02).  Conclusion: The results of this study indicate a positive correlation between total body fat with atherogenic Framingham risk score and from it we conclude that Total body fat measured on a standardized Bioimpedance weighing scale can be used as a screening tool to assess the modifiable cardiovascular risk factors and help in lowering the risk of future cardiovascular disease.

Introduction: COPD Is Chronic Progressive Irreversible Airway Disease That Results In Restriction Of Physical Activities. Patients With COPD Complain Of Cough With Expectoration, Shortness Of Breath On Excretions, Wheezing. Cigarette smoking, exposure to dust, Smoke Pollutants, and occupational exposure is the usual cause of illness. Patient with COPD may develop long-term complications like Right sided heart failure and bronchogenic Carcinoma. Aims To assess the electrocardiography, echocardiography, hematological and radiological changes to reduce morbidity & mortality effects in COPD. Materials and Methods: The present study was a Randomized control trial. This Study was conducted from December 2020 to May 2022 at Medicine Department of Katihar Medical College. Result: In our study we classified patient with moderate, severe and very severe disease as per the severity of disease and P Pulmonale was found as a common abnormality. The studies responding lower incidence of P Pulmonale might have been done a large no. of Patient without taking into consideration the severity of the disease and R/S ratio > 1 in lead V1 correlated well with severely of COPD. This finding was present in 2(5.88%) in Moderate COPD, 2(6.45%) in severe COPD and 6(17.44%) in very severe COPD. Conclusion: COPD is one of the most prevalent diseases of world. Most of the people in fifth sixth decade usually have the disease. Disease starts earlier and with advancing age increases in severity and older patients usually have severe or very severe disease. Severity also depends on duration of smoking and age at which smoking begins.

Introduction: Pterygium, derived from Pterygion (ancient Greek word means wing) is a slow growing proliferation of wing shaped common ocular surface lesion originating in the limbal conjunctiva within the horizontal palpebral fissure with progressive involvement of the cornea. Aims: To observe refractive error changes following primary pterygium excision and autologous stem cell grafting placed by suture. Materials and methods: The present study was an Institution based, longitudinal, observational, prospective study. This Study was conducted 9 month, between January 2019 and September 2019 at Outdoor and indoor of Department of North Bengal Medical College and Hospital. Total 50 patients were included in this study. Result: Pre-operative, post-operative DAY1, DAY7 and DAY30 visual acuity distribution were analysed statistically. Mean pre-operative visual acuity of the study subjects were 11.04 (sd =3.98). Whereas mean post-operative visual acuity were 10.740 (sd =3.78), 9.600(sd=3.48) and 7.80 (sd=2.48) respectively for DAY1, DAY7 and DAY30. Visual acuity significantly improved DAY7 (P≤0.001, mean difference=1.44) and DAY30 (p≤0.001, mean difference =3.24). There was no statistically significant improvement of visual acuity on DAY1 post-operative period (p≤ 0.16) but post-operative DAY30 visual acuity improvement was highly significant. Conclusion: Pterygium has direct impact on visual acuity, horizontal and vertical keratometric reading. There was no improvement of visual acuity on DAY1 post-operative period but post- operative DAY30 visual acuity improvement was highly significant. Both K1 and K2 value changed following operation. Mostly values were changed after 7th post-operative day. K1 values were changed more in compare to K2 values. Though required spherical glass power changes were not observed but cylindrical glass power changes were noted.

Introduction: In India, teenage pregnancy is an important public health problem.  Teenage pregnancies represent a high-risk group in reproductive terms. Complications of pregnancy and childbirth are the leading cause of mortality among girls aged 15-19 years. Aims and objectives of the study: To find out strategies for prevention of problems of teenage pregnancies and to study feto- maternal outcome of teenage pregnancy. Materials and Methods:  Teenage primigravida between 13 to 19 years who crosses 28 weeks of gestation were included in this study. The study includes 300 pregnant teenagers during a period of one year from May 2020 to April 2011at Burdwan Medical College & Hospital.  Results: The study showed that 53% of teenage pregnancy were associated with complications .10% had preterm birth, 8.3% had malpresentation, 8% had PROM, 7% had hypertensive disorder and 6.3% had severe anaemia. 30% had Cesarean Section. Majority of the babies were healthy babies. 20% were Low Birth Weight babies, 9% requiring NICU admissions Conclusion: Teenage pregnancy is associated with poor obstetrics outcome. Improving the status of women socially, economically, politically and implementing the interventions aimed at reducing teenage pregnancy will go a long way in achieving the goal of safe motherhood in India.

Introduction: Sodium levels should be between 135 and 145mEq/L. A cell's ability to maintain homeostasis is necessary for proper operation. An imbalance in the body's general water control may be the cause of abnormal sodium levels. High sodium levels caused by irregular water balance are present in chronic liver illness that is not yet fully reversible. Aims: To assess the correlation among serum sodium imbalance and prognosis in decompensated liver disease patients and its clinical relevance. Materials and Methods: It was a prospective hospital based observational study of 75 patients with biochemical and clinical evidence of chronic liver disease (CLD), who were admitted in the medical ward of Katihar Medical College, Katihar, since December 2020 to May 2022. Result: In present study, 69 (92%) patients were alcoholic, 1 (1.33%) had HCV, 5 (6.67%) had HBV, and none had primary biliary cirrhosis, cryptogenic cirrhosis, and autoimmune hepatitis. There was abdominal distension in 75 patients (100%), jaundice in 22 (29.33%), lower limb swelling in 75 (100%), GI bleed in 19 (25.33%), and altered sensorium in 15 patients (20%). Conclusion: It has been shown that low serum sodium is a poor prognostic marker and increases the risk of early mortality. The few available treatments for hyponatremia currently consist of appropriate free water restriction, stopping diuretics, and may be short-term vaptan (eg; Tolvaptan) usage.

Introduction: Recent years have seen an increase in our awareness of possible long-term effects of intrapartum strain on the pelvic floor. Structural damage to the anal sphincter during vaginal delivery may predispose to the development of anal incontinence, whether in the immediate postpartum period or later in life. Vaginal birth is a risk factor for anal incontinence in women. Objective - To determine the clinical characteristics of occult perineal tear and outcome after vaginal delivery diagnosed with transperineaL and/ endoanal ultrasonography in postpartum women Materials and Methods: This longitudinal study was conducted in the department of Radio diagnosis, IPGME&R and SSKM Hospital, which took the study period from 1st January, 2021 to 31stSeptember, 2022.The present study was carried on 100 patients, among them 27 patients with symptoms of anal incontinence and 73 asymptomatic patients. Result: In this study both trasperineal and endoanal ultrasonography was performed but majority of our patients refused for Endoanal ultrasonography during 1st visit and follow up visit. So a finding of Endoanal ultrasonography is not included in this study. In our study duration of 2nd stage of labour in relation to chances of occult perineal tear revealed majority of patients had prolonged 2nd stage of labour(out of 9 patients of occult perineal tear 7 patients had history of >90 minutes 2nd stage of labour). Conclusion: Patients having prolonged 2nd stage of labour (>90 minutes) tends to show more chance of occult perineal tear. Occult perineal tear is more common in primiparous women. Associated findings like tranperinal ultrasound at 6 weeks and 3 months after delivery does not show any significant difference in thickness of anal sphincter;

Introduction: Worldwide breast cancer is the leading type of cancer in women accounting for 25% of all cases. In 2012, it resulted in 1.68 million cases and 5, 22,000 deaths. It is more common in developed countries and is more than 100 times more common in women than in men. Aims: To correlate cytological diagnosis with histopathological diagnosis of breast lesions, accuracy of FNAC in diagnosing breast lesions and the cytomorphology of various breast lesions of patients. Materials and Methods: The present study was a descriptive Cross Sectional study. This Study was conducted from March 2021 to November 2022, department of pathology at Darbhanga Medical College. Total 100 patients were included in this study. Result: On histopathology, Fibroadenoma was diagnosed in 54 cases, 20 cases were of infiltrating ductal carcinoma, 10 cases were Fibroadenoma with Fibrocystic change and 8 cases were fibrocystic change. There was one case of Borderline phyllodes, Adenosis with myoepithelial hyperplasia, Ductal Carcinoma insitu, Mucinous Carcinoma. Conclusion: Benign neoplasms of the breast are more common than malignant one.The present study shows FNAC correlation with histopathology with high specificity and maximum positive predictive value. However, FNAC can be used as an indicative diagnosis (one stop) for breast cancer examination in outpatient setting. Accuracy of FNAC enables to proceed with surgery or not. It bridges the gap between clinical evaluation and final surgical pathological diagnosis in majority of cases. It enables the clinician to obtain a diagnosis in high percentage of cases with minimal expenditure of time, amd money and often to avoid unnecessary surgery.

Introduction: Previous studies reported an association of diabetes mellitus (DM) with TB susceptibility. Many studies were retrospective, had weak diagnostic criteria for DM, and did not assess other comorbidities. This study is addressing these limitations with a longitudinal comparison of patients with TB who are classified as diabetic or normoglycemic according to World Health Organization criteria. We report interim findings after enrolling 159 of a planned 300 subjects. Aims: Materials and Methods: Results: We expect that the trends in DM and pre-DM prevalence will be confirmed when the planned accrual is achieved. The varied prevalence of other TB comorbidities (smoking, alcohol consumption, undernutrition, and vitamin D insufficiency) and metformin treatment may also have influenced TB severity and treatment response. This will be comprehensively analyzed when full cohort data are available. Conclusions: Earlier study results reveal a strikingly high prevalence of glycemic disorders in Indian patients with pulmonary TB and unexpected heterogeneity within the patient population with diabetes and TB. This glycemic control heterogeneity has implications for the TB-DM interaction and the interpretation of TB studies relying exclusively on HbA1c to define diabetic status.

Introduction: Tuberculosis (TB) is a communicable disease caused by bacillus Mycobacterium tuberculosis (MTB). It is one of the leading causes of morbidity and mortality worldwide. Aims: To investigate delays and barriers in the diagnosis of TB in children and to investigate delays and barriers in treatment initiation in children with TB. Material and Methods: This cross-sectional study was conducted in the Department of Pulmonary Medicine and Paediatrics, Govt. Medical College, Patiala. A total of 126 subjects were enrolled in the present study. Children diagnosed with T.B (Pulmonary or extra pulmonary TB) attending the department of Pulmonary Medicine and Paediatrics, Govt. Medical College, Patiala over a period of one year was included in the study. Result: Health facility of the health care professional who made the initial TB diagnosis was chest hospital, Patiala in 65.87 percent of the patients while it was made in govt. hospitals in the remaining 28.57 percent of the patients. Health facility of the health care professional who made the initial TB diagnosis was in private practice in 5.56 percent of the patients. Conclusion: Health facility of the health care professional who made the initial TB diagnosis was chest hospital, Patiala in 65.87 percent of the patients while it was made in govt. hospitals in the remaining 28.57 percent of the patients. Health facility of the health care professional who made the initial TB diagnosis was in private practice in 5.56 percent of the patients.

Background: Depression is the commonest psychological problem that affects a woman during her perinatal period worldwide. The risk of prenatal depression increases as the pregnancy progresses and clinically significant depressive symptoms are common in the mid and late trimester. There is a paucity of research on depression during the prenatal period in India. Given this background, the present study aimed to assess the prevalence of prenatal depression and its associated risk factors among pregnant women in Central India. Methods: The study was nested within an on-going cohort study. The study participants included 500 All pregnant women attending antenatal OPD clinic and admitted patients in Department of Obstetrics and Gynecology,and ready to give written consent were included. The data was collected by using a structured questionnaire which included. Edinburgh Postnatal Depression Scale (EPDS) to screen for prenatal depression. Results: In our study occurrence of depression during pregnancyis 28.4% (142 out of 500) according to Edinburg’s Postnatal Depression Scale. If severity of depression is to be considered, out of total 142 study participants having antenatal depressive symptoms, 50 (35.21%) werehaving possible depression, 75 (52.81%) were having fairly high possible depression and 17(11.98%)werehaving probable depression.shows that 55 (38.73%) out of 142 study participants having antenatal depressive symptoms, belong to extremes of age group (less than 19 years and more than 35 years) Conclusion: The current study's observation of a high incidence of prenatal depression implies its importance as a public health concern. Consequently, health care plans may encompass antenatal care services, including screening and diagnosis of prenatal depression, in addition to other medical amenities offered.

Background: The impact of coronavirus disease 2019 (COVID-19) on maternal and newborn health is unclear. We aimed to evaluate the association between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy and adverse pregnancy outcomes. Material and Method: present study is a hospital-based observational study of Covid-19-positive pregnant women who gave birth in the dedicated Covid block of Gandhi Medical College Bhopal during the data collection period. After ethical clearance, patient records were evaluated and included in the study if they met the criteria. The research question, hypothesis, aims, and objectives guided the analysis. Descriptive analysis showed data distribution in terms of frequency and percentage. The novel coronavirus COVID-19, which originated in Wuhan, China, caused a global pandemic in December 2019. COVID-19 increases morbidity and mortality in immune-dysregulated pregnant women. Due to pandemic restrictions, prenatal examination have changed. We studied pregnant COVID-19-infected women. We examined maternal and neonatal outcomes linked to COVID-19 infection in pregnant women. Results: Our investigation revealed that 90 (42.8%) antenatal women admitted in our hospital from March to August 2020 and 120 (57.2 %) admitted during second wave January 2021-june 2022 (study period) were COVID-19 positive.The current investigation reveals that 42.4% of the study participants required ICU care during the initial wave of the COVID-19 pandemic, while 59% required the same during the subsequent wave and 4.4% in first wave 17.5% in second required mechanical ventilation.During 1st wave 4 maternal death were observed while in second wave 21 maternal death were observed. Only 3.5% of the new born tested positive and 28.9% were admitted in NICU. Conclusion-Pregnancy accelerated mild to moderate symptoms. As in the general population pregnant women also died more in the second COVID-19 pandemic. Pregnancy worsens moderate to severe illness requiring ICU care. These affected patients had more intrauterine foetaldeath, oligohydramnios, premature rupture of membranes, preterm delivery, intrauterine growth restriction, NICU admissions, and oxygen and mechanical ventilation needs. Our study suggests COVID-19 complicates medical or obstetric comorbidities. The neonate's risk of complications and NICU admission increases with severe mother symptoms or comorbidities.

Background: Osteoarthritis (OA) is characterised by joint damage, hyperplasia, and degeneration of articular cartilage. In Knee Osteoarthritis KOA pathophysiology, the immune and inflammatory systems are stimulated, and monocytes, neutrophils, lymphocytes, and platelets play significant roles. Neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) can indicate the balance of the immune response and have been described as independent and cost-effective predictors of numerous inflammatory and immunological illnesses. The present study aimed to study of Biochemical marker in Knee Osteoarthritis. Method: In the present case-control study, a total of 100 KOA cases and 100 healthy were enrolled as per inclusion-exclusion criteria. Patient data, including age, sex, blood cell counts, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels, red blood cell distribution width, and the Kellgren–Lawrence (KL) score were recorded. Result: The mean age in both cases [56.78±9.61] and the control group [55.37±8.42] were comparable. Male had dominancy in both groups over females however showed a non-significant difference among both groups. Majority of patients were of OA Grade-II (56%). While ROC analysis, all markers showed significant observation (except RBC) with maximum AUC in lymphocytes (0.9871) and neutrophils (0.8310). Amongst the ratio, NLR showed the most significant AUC (0.7815) and correlation (r=0.423) values. All parameters showed a significant correlation with OA grade except Age [p=0.1526], Platelets [p=0.0986], and red blood cell distribution width [p=0.0705]. Conclusion: NLR has a high diagnostic value for KOA, so that it could be a trustworthy marker. However, further multi-centre studies need to increase the reliability of the present observations.

Introduction: A morphometric study of the upper end of the dry tibia bone explores the anatomical features and measurements of the tibial plateau, which is vital in knee replacement surgeries. By analyzing these dimensions, this research aims to uncover valuable insights with clinical significance. Understanding the morphometry of the tibial plateau facilitates implant design, surgical technique refinement, and patient-specific considerations, ultimately enhancing the accuracy and success of knee replacement procedures. Materials and Methods: In this cross-sectional and prospective study, 60 adult tibias (among which 30 belong to the right side and 30 belong to the left side) of unknown gender and age were studied in the Department of Anatomy, Nalanda Medical College & Hospital, Patna, Bihar. Using a digital vernier caliper, various upper-end characteristics were measured on a fully osseous, dried, macerated, and carefully cleaned tibia. Results: We observed that the mean anteroposterior diameter of the medial condyle was more than the lateral condyle, while the transverse diameter was more in the case of the lateral condyle on both sides. It was observed that the anteroposterior diameter of the intercondylar area was more on the left side. The transverse diameter of the intercondylar area of the upper end of the tibia at the anterior end as well as the middle narrow part was found more on the left side, while that of the posterior end was more on the right side. But the difference between the right and the left side was statistically insignificant. Conclusion: This study and its clinical significance in knee replacements seek to enhance our understanding of the tibial plateau's anatomical variations and their impact on surgical outcomes. By shedding light on these crucial aspects, we aspire to improve surgical precision, implant selection, and patient outcomes in knee replacement surgery.

Geriatric anemia is a global health problem because of its high prevalence and associated significant morbidity and mortality. Aim To perform hematological evaluation of anaemia in 200 geriatric patients.  Research Design and Methods This was a hospital-based prospective observational study, conducted in 200 patients aged 60 years and above at SIMS, Hapur, NCR, a tertiary care center of North India from July 2022 to Dec 2022.  The hemoglobin level below 13 g/dl in men and below 12 g/dl in women is taken as anaemia. Results A total of 200 patients of age 60 years and above with anemia were evaluated for various hematological parameters. Data analysis was done using laboratory parameters like hemoglobin, Packed cell volume, MCV, MCH, MCHC, ferritin, transferrin saturation, C-reactive protein, vitamin B12 and folic acid.  Medical history and demographics was taken into consideration. Out of 200 patients, the etiological distribution of anemia showed Anemia of chronic disease (ACD) in 76 patients (38%), to be the most common cause , especially  Chronic kidney disease (CKD) in 37 patients(18.5%). This was followed by iron deficiency anemia in 65 geriatric patients (32.5%), multifactorial cause in 10 (5%), vitamin B12 deficiency in 13 (6.5 %), Anaemia due to hematological cause in 13 patients( 6.5%) folate deficiency in 6 (3%). No etiology for anemia could be found in 17( 8.5%) patients . Conclusions In most of the cases, anemia in the elderly had a treatable cause. Thus, a thorough investigation including gastrointestinal endoscopy is warranted. Unexplained progressive or unresponsive anemia requires bone marrow examination.

Background- 'Liver abscess' is a common medical condition in India and has a high mortality ratedue to delayed detection and treatment. Based on the available literature, ruptured liver abscess occurs in 2- 17% of patients and is associated with a mortalityrate of 12%-50%. Currently, these patients are treated with antibiotics along with percutaneous needleaspiration (PNA) or percutaneous catheter drainage (PCD) or surgical drainage, used only for patients who do not respond to these treatments. Therefore, this study aims to evaluate outcomes associated with different treatment strategies for liver abscess. Methods- In the present study, all patients of Ruptured Liver abscess were selected from MYH Hospital Department of Surgery Indore MP,during the period from September 2020 to September2021. Patient was treated conservatively if the size of abscess rupture into subphrenic space, perihepatic space, right paracolic gutter, and right pleural cavity. Percutaneous pigtail catheter was inserted in abscess cavity and collection space under USG guidance. Pus aspirated was then sent for culture and sensitivity. Result- In our study on the basis of outcomes among pigtail and laparotomy procedures-death rate was 13.3 % (higher) in laparotomy procedures than pigtail procedures 6.7 %. And successful rate higher in pigtail procedure (93.3%) than laparotomy procedures (86.7%) . Hence pigtail procedures were better than laparotomy procedures in ruptured liver abscess on the basis of outcome (death rate and success rate). Conclusion: Laparotomy procedures had a higher death rate than pigtail procedures (6.7%). Pigtail procedures (93.3% successful) outperform laparotomy procedures (86.7%). Pigtail procedures performed better than laparotomy in ruptured liver abscess in terms of mortality and success.

Background: Trauma is reported to be the leading cause of death, hospitalization and morbidity in young population. Road traffic accidents (RTAs), fall from height, occupational injuries, and assault are the usual etiologies, RTAs being the commonest. Material and Methods: All the patients presenting with traumatic injury to the thorax with or without other associated injuries, between February 2019 to January 2023   at our centre were included in the study. Patient data  collected  comprised of demographic information of the patient, characteristics of injury, primary diagnosis, associated thoracic and non-thoracic injuries, medical and surgical interventions, and outcome of the injury.Results and Observations: There were 549 (65.6%) male and 288 (34.4%) female patients whose ages ranged from 2 years to 92  years with  mean age of  35.72 ± 15.18 years. There were 688 (82.2%) patients with blunt traumas and 149(17.8%) patients with penetrating traumas. In blunt thoracic trauma the most common mechanism was road traffic accident (n= 424, 61.6%), followed by fall from height (n=183, 26.5%), occupational accident (n=44, 6.3%), and assault (n=37, 5.3%). Rib fractures were the most common type of injury in our series and  presented in 498( 59.5%) patients. After rib fractures pneumothorax was the second most common type of injury (n=399, 47.7%),  followed by hemothorax (n=289, 34.5%), lung contusion (n=223, 26.6%). Approximately two-third  of the patients were having concomitant associated  injuries  (n=502 ,59.9 %), the commonest being extremity fracture (n=214, 42.6%). Tube thoracostomy (n=432, 51.6%) was the most common surgical intervention in our patients, followed by thoracotomy (n=16, 1.9 and conservative management  (n=389,46.4%) . The mean hospital length of stay (LOS) was 4.1 ± 3.6 days. The mortality rate was 0.9 % (8 out of  837 ). Hemorrhagic shock (n=5) and respiratory failure (n= 3) were the most causes of death.Conclusion: Middle aged  males owing to more outdoor activities and vehicular accidents bear most of the brunt of blunt chest trauma thus affecting the most productive age group of population. Rib fracture followed pneumothorax and hemothorax were the commonest injuries. Often a combination of these injuries were present.Majority of patients with blunt chest injuries can be managed at the level II trauma centre like ours.

Background: Abnormal uterine bleeding is a most common gynecological problem that affects all age groups. One third of patient attending gynae OPD present with complain of abnormal uterine bleeding 3 . Bleeding is said to be abnormal when the pattern is irregular, abnormal duration (>7 days), menorrhagia or abnormal amount (>200 ml/menses). Aims And Objectives: The study was done for evaluation of histopathological pattern of endometrium and frequency of carcinoma of endometrium in  patient with history of abnormal uterine bleeding in perimenopausal and postmenopausal women. Methods: The study is carried out for a period of one year from June 2021 to May 2022. A total number of 67 cases were studied during this period. The data were analysed Results: Proliferative endometrium more commonly seen in perimenopausal age group. Atrophic endometrium more common in postmenopausal age group. Conclusion: The present study showed that the endometrial finding both in peri and postmenopausal group. Also seen in the study is that the endometrial carcinoma more common in postmenopausal women than perimenopausal women.

Introduction: Amidst the growing scare of antibiotic resistance, the institution of appropriate antibiotic therapy is imperative in the proper management of perforation peritonitis. Objective:In this study, the objective was to find out the common microbial involvement in cases of gastrointestinal perforation along-with their sensitivity to commonly used antibiotics.Methods: This was a retrospective, multi-centric observational study conducted in four tertiary care hospitals of a developing country over a period of 12 years. The records of all the patients operated for gastrointestinal perforation peritonitis during this period were retrieved and analysed. Only those patients were included in the study in which the culture/sensitivity reports of peritoneal fluid were available.Results: A total of 1312 patients were included, among which, 854 (65.1%) were males and 458 (34.9%) were females. The mean age of the patients was 47.1 ± 13.8 years. Upper gastrointestinal perforations were identified in 362 (27.7%) patients and lower gastrointestinal perforations were seen in 943 (71.9%) patients. A single bacterium was isolated in 665 (59.9%) patients, and two bacteria were isolated in 245 (22.1%) patients. The most common organism to be cultured was Escherechia coli [644 (58.1%) patients]. The frequency of sensitivity for each microbe was highest for meropenem (P<0.05).Conclusion: We conclude that Gram-negative Enterobacteriaceae are the usual suspects in cases of perforation peritonitis, and are usually sensitive to meropenem.

Background: Hypertension, one of the most important risk factors for cardiovascular disease, which includes coronary artery disease, heart failure, and cerebral stroke. It has been confirmed that an increase in systolic blood pressure by 20 mmHg and diastolic blood pressure by 10 mmHg doubles the risk of death. There is an increasing rate of mortality as a result of cardiovascular disease, the number of deaths associated with hypertension in the United States increased by 61.8%.The prevalence of hypertension in India is about 30%, and the urban population had markedly high level of hypertension compared to rural population. A meta-analysis revealed that the pooled prevalence of hypertension for the rural and urban north Indian population was 14.5% (13.3–15.7) and 28.8% (26.9–30.8), respectively. Aims: To evaluate Medication Adherence among Hypertensive patients. Methods: A cross-sectional study was conducted at Department of Pharmacology in collaboration with Department of Medicine, Govt. Medical College, Patiala. Patients attending Medicine OPD with a diagnosis of Hypertension, who satisfy the inclusion criteria will be selected. Medication adherence was tested using the validated nine item Hill-Bone Medication Adherence Scale (HB-MAS).  The data will then be evaluated and computed for statistical analysis of various interactions and correlations. Results: Out of 200 patients, the mean age of the participants was 63.45±11.09 years. The male to female ratio was 1:0.9. 53% patients were males. 58% of the patients were obese, 28% overweight, 13% normal and 1% underweight. 72.5% patients’ treatment adherence was good, for 14.5% moderate and for, it was 13% poor.Conclusion: The outcome of the current study revealed that there is a good adherence status among the study participants. The analysis clearly demonstrated that younger age and lower BMI were the main factors responsible for poor treatment adherence

Background: The Ambu® Aura40™ is a reusable supraglottic device made up of silicone. It features a built-in curve that carefully replicates the natural human anatomy of the upper airway and has the flexibility needed to adapt to individual anatomical variances and a wide range of head positions. Methods: We report a series of 5 patients scheduled for elective operative procedures managed with Ambu Aura40TM LMA. A balanced anesthesia technique was used and maintained with vecuronium and isoflurane. Results: The mean insertion time of Ambu Aura 40™ LMA  is (33.20 + 4.97) seconds. The first insertion attempts were successful in 80% of patients i.e. 4 out of 5 cases and in only one case second attempt was required. In 3 out of 5 cases (60%), no resistance was experienced during insertion. The hemodynamic profiles of patients during a peri-insertion period of Ambu Aura40™ LMA remain stable in all the cases. Only one patient developed a sore throat in the postoperative period and blood on the device was not present in any case. Conclusion: As an LMA with enhanced features and reliability Ambu Aura40™ has the potential for airway solutions in patients undergoing operative procedures.

Background: The prevalence of chronic kidney disease (CKD) has increased in the Indian population during the past three decades. Anaemia is a serious problem in chronic kidney disease due to iron deficiency and low erythropoietin levels. Low haemoglobin levels impact patients' quality of life and raise their risk of cardiovascular disease (CVD) and mortality. Much of the mortality and morbidity in patients with renal failure can be related to the secondary effects of chronic anaemia. Objective: to analyse the effects of normalizing haemoglobin levels with exogenous erythropoietin injection supplement on a patient with anaemia secondary to chronic kidney disease. Methods: 60 patients with chronic kidney disease and anaemiawere observed during this study. As per criteria and after approval from ethical committee study was conducted in our institute. Patients were given erythropoietin alfa on a periodic basis and observed with blood parameters on monthly basis to see the effects of normalization of haemoglobin. Results: Normocytic normochromic anaemia was the predominant type; Diabetes nephropathy was the most encountered form of renal disease followed by chronic glomerular disease and chronic interstitial disease. Improved haemoglobin levels did have statistical end result. Conclusions: Renal anaemia can be corrected with erythropoietin in a chronic kidney disease patient. Regular and consistent dose of exogenous erythropoietin does make significant change in patient’s quality of life as well as improved organ vitality. Iron correction is a must along with erythropoietin to reap its entire benefit.

Pre-analytical mistakes have previously been proven to contribute a considerable fraction of laboratory errors and to a variety of patient safety hazards. Accreditation against ISO 15189:2012 requires laboratories to assess the influence of pre-analytical procedures in areas such as non-conformance identification and control, continuous improvement, internal audit, and quality indicators. Introduction: There are several data gathering methods. Audit, manual recording techniques, incident reporting mechanisms, and laboratory information systems are some of the data gathering methods available. Material and methods: Samples received at Biochemistry collection Centre of Rama medical college hospital and research Centre. To compile data on critical errors, a database was designed to record the errors occurring in the laboratory, when pre-analytical requests are manually entered into the software Results:- The Runs Test was applied to assess changes in the trend of the series, assuming statistical significance at P < 0.050. To determine the annual volume of requests and statistically significant indicators according to the Runs Test, the base 100 index was calculated with respect to the year. Conclusions: This study offers a comprehensive, patient-centered examination of the extent of pre-analytical mistakes, in compliance with the standards of the International Standard for the certification of medical labs, integrating all sub-processes and individuals engaged in the pre-analytical process

Aim: We carried this study to compare readymade 0.75% hyperbaric ropivacaine vs conventional 0.5% hyperbaric bupivacaine for elective C-sections. Methods: Our study included 60 parturients aged 18-30 years with ASA grades I/II who were scheduled with caesarean section. The parturients were randomly split into two groups of 30 each. Parturients in Group B received 0.5% hyperbaric bupivacaine 2ml (10mg), whereas those in Group R received 0.75% hyperbaric ropivacaine 2ml (10mg) (15mg). Results: The onset of motor anaesthesia was quantified in seconds as the achievement of Bromage scale II. Group B had a time of 97.5±33.82 and Group R had a time of 102.63±23.18 seconds. The P-value was significant (<0.05). The ultimate bromage scale obtained was measured in both groups, with 19 (63.33%) parturients out of 30 achieving Bromage III and 11 (36.66%) achieving Bromage IV in the ropivacaine group. In the ropivacaine, the median Bromage Scale was Bromage III. In the bupivacaine group, 13 out of 30 achieved Bromage III and 17 achieved Bromage IV. Two segment regressionwas quicker in Group R than in Group B. Conclusion: In caesarean sections, hyperbaric ropivacaine is an acceptable substitute for hyperbaric bupivacaine. The use of sterile 0.75% hyperbaric ropivacaine ampoulesis equivalent and even better than those hyperbaric ropivacaine solutions made artificially shortly before the treatment, is an extra benefit of the current research.

Background: Breast cancer is the foremost cause of cancer related death in young females; hence early detection of breast cancer carries much importance. This study is done to determine the incidence of Malignancy in all breast lumps in patient admitted in Department of general Surgery, RAMA medical college and hospital,Hapur. Material & Methods: This Prospective study was conducted between January 2021 to September 2022. 50 consecutive patients admitted in Inpatient department with complaints of a palpable breast mass were included  . Each patient underwent a modified triple test which included a complete clinical examination, ultrasound examination and mammography of the breast mass and finally Fine Needle aspiration and histopathological test of specimen obtained from the breast lump was done.  Results: Out of the 50 patients,12 (24%) patients were between the age group of 10 to 20 years, 12(24%)  patients were in the age group of 21 to 30 years and 13(26%) patients were in the age group of 31to 40 years. 14(28%) patients were nulliparous while 36(72%) were multiparous.  Most of the patients 15 (30%) had symptoms for the duration of 4 to 6 months.Pain over lump was present in 26(52%) patients while nipple discharge was present in 9(18%) patients. Majority of the females (60%) had their onset of menarche between 12-15 years. Upper outer quadrant of the breast was found to be most commonly involved with tumor in 25 (50%). A lump size of 3 to 4 cm in maximal diameter was found in 17 (34%) patients. 35(70%) patients had lumps which were firm in consistency. 38 (76%) patients were subjected to Excision biopsy, 3 patients (6%) were treated with BCS  and 9 patients (18%) underwent Modified Radical Mastectomy. 41(82%) patients with lumps were diagnosed to have benign lesions on histopathology while 9 (18%) patients had malignant lesions. Fibroadenoma was the most common benign breast tumour, seen in 31 out of 41 patients (75%). Of the malignancies proven by histopathology (9 patients), 7 patients had invasive ductal carcinoma (77.8%). Conclusion: Age is important risk factor for malignant lesions. Majority of the females with benign diseases are premenopausal and majority of the patients with malignant lumps are post menopausal in our study. Fibroadenomas are among the most common benign lesions of the breast while invasive ductal carcinoma is the most common of the malignant lesions of the breast.

Introduction: Chronic otitis media is relatively common and potentially dangerous disease of the ear. It is often characterized by cholesteatoma that causes local destruction and osseous erosion leading to complications. Its management is mainly surgical, mostly a canal wall up and down tympanomastoid surgery. High resolution computed tomography (HRCT) is the imaging modality of choice for evaluation of middle ear structures and pathology. The aim of this study is to identify causes of failure and its management with special reference to CT scan. Aims: Evaluation of different causes of revision tympanomastoid surgery, assessment of their outcome, and ascertaining the possible measures to prevent further recurrence. Materials and Methods: This Prospective descriptive study conducted at department of ENT, IPGMER & SSKM Hospital, Kolkata from 1year&6 months (April, 2020 to September, 2021). Result: 30 (60.0%) patients had Modified Radical Mastoidectomy Surgery and 20 (40.0%) patients had Radical Mastoidectomy Surgery. 41 (82.0%) patients had Cavity obliteration Palva flap. 23 (46.0%) patients had Cavity obliteration Bone dust. 26 (52.0%) patients had Cavity obliteration Cartilage. 41 (82.0%) patients had Adequate in Conchomeatoplasty Size Post-operative findings 1 Month. A significant improvement in mean air conduction level, mean bone conduction level, and mean air-bone gap (ABG) was found postoperatively (p < 0.05). For all types of ossicular chain reconstruction, a significant improvement in mean Pure Tone Average was observed (p < 0.05).Conclusion: A revision canal wall down surgery, if performed successfully following all the basic principles of tympanomastoid surgery, can help achieve a safe and dry ear and can significantly improve the subjective well-being of the patients.

Introduction: Teenage pregnancy is defined as “pregnancy occurring between 10-19 completed years at the time of delivery”1. Early marriages are still a social problem in our society specially in developing countries like India where the adolescent individuals face a lot of issues involving changes in hormonal, emotional and psychological level. Teenage pregnancy implicates so many adverse outcomes both in maternal and fetal health. Objectives: To study the incidence of pregnancy in teenage group and to evaluate the maternal and fetal adverse outcome of teenage pregnancies for the sake of prevention. Materials and Methods: This observational prospective study was undertaken with 115 teenage pregnant mothers over a period of 12 months from 1st April 2021 to 31st March 2022 at Department of Obstetrics and Gynaecology, Midnapore Medical College and Hospital. Required details were collected on a pre designed proforma from admission to delivery and were analysed. Results: Incidence of teenage pregnancy in present study was 8.4%. Maternal complications like anaemia (72%), HDP (28%), preterm labour (30%), PROM (20%), post-dated pregnancy (23%), obstructed labour (16%), PPH (10%) and complications like IUGR (15.6%), LBW (58%), respiratory distress (14%), hyperbilirubinemia (14%), congenital anomalies (1.7%) among fetal complications were seen in teenage pregnancies. Conclusion: Maternal and fetal morbidity and mortality due to teenage pregnancy is still a common problem in our society.

Background: Hypertension is the most common medical disorder in pregnancy, complicating 6-10% pregnancies1. Treatment of severely increased blood pressure is widely recommended to reduce the risk of maternal and fetal complications. Regimens for acute treatment of severe hypertension in pre-eclampsia include intravenous medications. Although effective, these drugs require venous access and careful fetal monitoring and might not be feasible in busy or low resource environments. Therefore, this study aimed to compare the efficacy of intravenous labetalol and oral nifedipine for control of hypertension in severe pre-eclampsia. Objective: To compare efficacy of intravenous labetelol and oral nifedipine when used rapidly to lower high blood pressure in severe pre-eclampsia mothers. Methodology: This is a hospital based prospective randomized interventional comparative trial conducted at Midnapore Medical College and Hospital from April ’21 to Sep ’22. The study has a sample size of 100 patients divided into two groups randomly, group A received intravenous labetelol injection (in escalating dose of 20,40, 80 and 80 mg every 30 mins, maximum dose of 220mg) and group B received oral nifedipine (10mg tablet orally upto 5 doses) every 30 mins2. Target BP is ≤ 150/ 90 mm of Hg. After target BP is reached further antihypertensive given as per choice. Results: In labetalol group 18 (32%) patients achieved target blood pressure with 1 dose, 10 patients (20%) with 2 doses, 14 (28%) with 3 doses and 8 (16%) with 4 doses while in nifedipine group 16 (32%) of patients achieved target blood pressure with 1 dose, 12 patients (24%) with 2 doses, 10 (20%) with 3 doses, 8 (16%) with 4 doses and 4 (8%) with 5 doses and P value is non significant (0.29).The mean average reduction in systolic blood pressure and diastolic blood Pressure after 30 minutes of drug administration was 6.04± 7.38mmHg and 6.88±4.8mmHg for labetalol and for nifedipine it was 4.32±4.22mmHg and 5.12±3.9mmHg with a non significant P value of 0.469. The mean time required to achieve target BP in Group A was 67.2±33.168 minutes and In Group B was 73.2±38.475 minutes with a P value of 0.405 which stands non significant. Conclusion: Oral nifedipine and intravenous labetalol regimens are almost equally effective in acute control of blood pressure in severe preeclampsia.

Congenital long QT syndrome is an inherited cardiac disorder characterized by prolonged ventricular depolarization and risk of sudden cardiac death. A 40 year old female patient, resident of Murshidabad, West Bengal, presented to the ER with recurrent episodes of dizziness and 3 episodes of syncope in the last 3 months. Bradycardia can occur in all forms of congenital LQT syndromes. Loss of repolarizing IKs in LQT1 leads to profound increase in cycle length of SAN cells, thus generating sinus bradycardia. Also, many KCNQ1 mutations are associated with sinus bradycardia. Early diagnosis with implantation of a dual chamber ICD in long QT syndrome patients with bradycardia can definitely add years to life in these patients.

Introduction: Perinatal asphyxia refers to a condition during the first and second stages of labour in which impaired gas exchange leads to fetal hypoxemia and hypercarbia which in turn can lead to cerebral edema and various circulatory disturbances. Aims: Role of cranial ultrasonography and colour doppler study of cerebral arteries in predicting neuromotor outcomes in newborns with perinatal asphyxia; A prospective/follow-up study. Material and methods: The study was conducted to assess the neuromotor outcomes in newborns with birth asphyxia by cranial ultrasonography and colour Doppler study of cerebral arteries. According to the inclusion and exclusion criteria, a total of 85 patients diagnosed with Birth asphyxia and complicated by hypoxic-ischemic encephalopathy (HIE) were selected for the study randomly from the SNCU & NICU, Department of Paediatrics, Murshidabad Medical College & Hospital, Murshidabad, West Bengal. Result: Majority of them (58, 68.2%) had poor outcome. Gross motor delay was most common complication (40, 47.1%), followed by Fine motor delay (26, 30.6%), Social delay (22, 25.9%), Language delay (18, 21.2%), Persistent seizure (18, 21.1%) and impaired vision and hearing (6, 7.1%). Some of them died (6, 7.1%) before the follow up. Conclusion: According to the present study, Transcranial ultrasonography and resistive index values of anterior and middle cerebral arteries showed high diagnostic accuracy, sensitivity, and specificity in predicting neuromotor outcomes in term newborns with birth asphyxia.

Introduction: "Globus sensation" is often described as the sensation of a lump in the throat associated with dry swallowing or the need for dry swallowing, which disappears completely during eating or drinking and for which no organic cause can be established. The globus pharyngeus has been defined as consisting of a persistent or intermittent sensation of a lump or foreign body in the throat for at least 12 weeks, occurrence of the sensation between meals absence of dysphagia or odynophagia; absence of pathological reflux, achalasia or other motility disorder with a recognized pathological basis globus is a painless symptom and frequently improve with eating. Aims: To study the anxiety and depression in patients suffering from globus pharyngeus. Materials and Methods: The present study was a cross sectional; hospital based single cantered observational study. This Study was carried one and half years at NRS medical college and hospital. 80 patients were included in this study. Result: In our study, out of 80 patients, most of the patients were 31-40 years old. Age was statistically significant. The mean Age of patients was [34.8625± 7.7700]. We found that, female population was higher than male population but this was statistically significant. It was found that, most of the patients were belong to Lower class and though and higher number of patients were from rural area followed by Urban area but these were statistically significant. We observed that, lower number of patients were Unmarried though it was statistically significant. In our study, more number of patients were from Joint Family followed by Nuclear family which was not statistically significant. We found that, most of the patients had No Anxiety and Depression [41(51.1%)]. Anxiety disorder was 20 (25.1%) patients and Depressive episode was 19 (23.8%) patients which was statistically significant (p=.00034). Conclusion: We found that, most of the patients had No Anxiety and Depression [41(51.1%)]. Anxiety disorder was 20 (25.1%) patients and Depressive episode was 19 (23.8%) patients which was statistically significant (p=.00034). Our study showed that, most of the patients had ≤17 Mild HAM A and more number of patients had <10 normal HAM D which were statistically significant.

Introduction: Myocardial infarction (MI), the end outcome of coronary artery disease (CAD), continues to be a major cause of mortality and morbidity worldwide. Over the past 50 years, it has been abundantly obvious that the series of thrombotic events that occur after an atherosclerotic plaque rupture obstructs the coronary artery, cutting off the oxygen and blood supply to the myocardial and leading to infarction. Aims: To assess the relationship between N-terminal pro- Brain natriuretic peptide levels on admission in ST elevation myocardial infarction (STEMI) and its short term complications, to determine the value of NT-pro-BNP in predicting short term outcome in patients with STEMI and compare the effectiveness of NT-pro BNP with cardiac troponin T and left ventricular ejection fraction in predicting the short term outcomes in STEMI. Materials and method: The present studywas a cross-sectional study. This study was conducted from April 2021 to November 2022in Patna Medical College and Hospital, Patna were included as cases. Total 40 patients were included in this study. Result: Out of the 40 patients studied, 45 % of the patients had ALWMI, 15 % had ASMI, 32. 5 % with IWMI and 7. 5% with IWMI+RWMI. 23 (57. 5%) were smokers. The relation between smoking and NT- pro BNP was not statistically significant. NT- pro BNP levels in the full cohort ranged from 246 to 3000 pg/ml. The mean levels were 1585. 65± 999 .133 pg/ml with the median NT- pro BNP as 1483 .50 pg/ml. There was a significantly higher incidence of arrhyhmias (p – 0.001), cardiac failure (p– 0.043), lower ejection fraction (p-< 0.020) and deaths (p-0.024) in the group who had above median NT- pro- BNP values. All 13 patients who had complications belonged to the above median NT pro BNP group. (p- <0.0001). The relation between the cardiac troponin T values, NT- pro BNP values, complications and deaths were not statistically significant. There was no statistical significance in the relation between LVEF < 50 % and the occurrence of complications, deaths. However there was strong correlation between LVEF < 50 % and NT- pro BNP above the median. (p – 0.020). Conclusion: NT-pro BNP is a superior short term prognostic indicator than cardiac troponin T and LVEF. It is a valuable tool for risk stratifying acute MI patients so that suitable treatment options may be developed and NT-pro BNP is a powerful predictor of short term prognosis in AMI, including mortality.

Introduction: Hypernatremia is serum sodium less than 135 meq/L. Hypernatremia is the most common electrolyte disorder. Its homeostasis is vital to the normal physiologic function of cells. A disturbance in body water homeostasis is a common feature of advanced cirrhosis. Aims: To study the prevalence of hypernatremia (<130mMol/l) in cirrhosis of liver and the association between hypernatremia and complications in cirrhosis of liver and its prognostic significance. Materials and method: This prospective research included 100 patients hospitalized to the Department of Medicine at PMCH in Patna. The research was carried out at PMCH Department of Medicine in Patna. This research was carried out between April 2021 and November 2022. This research covered 100 patients. Result: There was significant difference in three groups of ≤130 meq/L, 131-135 meq/L and ≥136 meq/L with respect to the complications of liver cirrhosis namely portal hypertension, hepatic encephalopathy, hepatorenal syndrome (p value = 0.0111, <0.0001, 0.0140 respectively). However no statistical significant difference was found in three groups with respect to ascites, gastrointestinal bleeding and coagulopathy (p value= 0.0621, 0.6904, 0.7094 respectively). There was significant difference in three groups of ≤130 meq/L, 131-135 meq/L and  ≥136 meq/L with respect to the complications of liver cirrhosis namely portal hypertension,  hepatic  encephalopathy,  hepatorenal  syndrome  (p value= 0.0111,  < 0.0001, 0.0140 respectively). However no statistical significant difference was found in three groups with respect to ascites, gastrointestinal bleeding and coagulopathy (p value= 0.0621, 0.6904, 0.7094 respectively). Conclusion: Low serum sodium levels in cirrhosis are linked to serious consequences of liver cirrhosis such hepatic encephalopathy and hepatorenal syndrome, and causes high morbidity and mortality. Hyponatremia is common in cirrhotic individuals. Hyponatremia in cirrhosis patients leads to poor prognosis. To avoid potential liver cirrhosis consequences, hyponatremia must be treated.

production and function. They represent the most common single-gene disorders that are found in humans and are distributed in various frequencies throughout the world. Materials and Methods: The present study was undertaken in the Department of obstetrics and gynecology of S.C.B Medical College, Cuttack during the period from july 2020 to july 2022. Result: Majority women (78.79%) attended for first antenatal check-up after 28 weeks of gestation and only 3.03% came before 12 weeks. So most of the women were not amenable to undergo prenatal diagnostic test like chorionic villus sampling to detect the fetal affection; Conclusion: As pregnancy is greatly affected by hemoglobinopathy. The maternal morbidities like pre eclampsia, pre-term labour, Urinary tract infection, asymptomatic bacteruria, antepartum haemorrhage and neonatal morbidities like low birth weight, IUGR, SNCU admission rate, neonatal mortality increase in women with hemoglobinopathy.

Introduction: Sexual behaviour is an important aspect of health which has the ability to impact the overall wellbeing of both men and women. Often sexual functioning disorders prevalence is very high among men and women of all age, ethnicities and cultural background. Premature Ejaculation (PME) and Erectile Dysfunction (ED) are encountered in clinical setting most commonly among male sexual dysfunction. In India cultural myths, superstitions and religious philosophies addressing sex as taboo. Aims: To study the anxiety and depression in men suffering from premature ejaculation. Materials and Methods: A cross sectional, hospital based, single centred observational study was conducted. The study period was one and half year after approval from Health University and Institutional Ethics Committee. 100 patients were included in this study. Result: In our study, most of the patients had Anxiety with Depression [34 (34.0%)] but this was statistically significant (p=.0164). In our study, the mean HAM-A of patients was [15.2000 ± 8.4303], mean HAM-D of patients was [13.6700 ± 8.2267]. Conclusion: In our study, most of the patients had Anxiety with Depression [34 (34.0%)], 24% patients had only anxiety disorder and 23.0% patients had only depression this distribution was statistically significant (p=.0164).

Tissue Doppler and Strain imaging allow noninvasive measurement of regional function of the myocardium.It is well validated for assessment of regional LV fuction.Recently these technique have also been used for the assessment of LA function. LA function as assessed by tissue Doppler velocities and strain imaging is lower in patients of severe Mitral stenosis. LA reservior function assessed by Global longitudinal strain(GLA) imaging improves within 24 hours after Balloon Mitral Valvotomy. Objective: assessment of left atial function in Mitral stenosis which is reduced in comparision to normal age/sex match population, by tissue Doppler and strain imaging, and also assess the effect of BMV on LAfunction. Methods: In this study 25 patients of Mitral stenosis planning for Balloon mitral valvotomy and 25 normal individuals were enrolled. Echocardioraphy was done on each individual for detail evaluation of Mitral valve, LA,LV and other structures. Left Atrial regional function and deformation properties were studied using Tissue Doppler Velocities, Strain imaging, before and after 24 hrs of balloon mitral vulvotomy and all details were plotted in tables and statistically analysed. Results: Our study demonstrates that atrial Tissue Doppler velocities, Strain imaging is a feasible method for assessment of left atrial function. It can be applied to evaluate impairment of atrial reservoir function in severe Mitral Stenosis. Balloon Mitral Valvotomy tends to normalize these abnormalities within 24 hours after the procedure. Global LA strain can be taken as an indicator of left atrial function, and its improvement following valvotomy may be taken as a good indicator of successful BMV.

Aim: To study epidemiological and clinical profile of Scrub typhus in hospitalised patients of SMS hospital, Jaipur. Materials and Methods: All the cases of febrile illness diagnosed as scrub typhus were analysed. Diagnosis was made by ELISA based IgM serology. Results:  Of the 159 cases, 29.56% belonged to age group 18 - 25 years and female populations were more commonly affected 55%. Common symptoms were high grade fever, headache, myalgia, cough and breathlessness followed by nausea and vomiting. Eschar was seen in 28 cases (17.6%) and the common sites were axilla, chest and groin. Thrombocytopenia was present in (68.5%) 109 patients. Liver enzymes were elevated in (80.5%) 128 patients. MODS (in 39 patients, 24.5%), Hypotension (40 patients, 25.16%), ARDS (8 patients, 5%), A.K.I. (6 patients, 3.7%), were some of the important complications. 2 patient sucumbed to death. All were treated with doxycyclin or azithromycin. Conclusion: There is a definite need to increase awareness among people as well as primary physicians and have high index of suspicion, especially in the light of increasing number of patients presenting with atypical manifestations.

Introduction Iron deficiency anaemia during pregnancy is one of the most common and intractable nutritional problems in the world as well as in India today. Traditional treatment for anemia based on either oral iron or blood transfusion or both, has had drawbacks. Thus iron sucrose and recombinant human erythropoietin can become promising management options. Objective To assess improvement in anaemic state and the duration required for the improvement in hematological parameters with or without injection erythropoietin in pregnant females receiving iron sucrose. Method And Materials Randomized control trial was conducted on 212 anaemic pregnant women (Hb < 11 gm%) for analysing the comparison of patient response to parenteral iron sucrose alone (Group A = 104 patients) with Inj. Recombinant Human Erythropoietin (rhEPO) along with routine tab iron (Group B = 108 patients),from November 2020 to October 2022. Data related to demography, clinical history along with various blood parameters were collected, analyzed and compared between the two groups. Result Mean pre- and post-treatment Hb was 8.86 ± 0.79 gm% and 9.77 ± 0.56 gm% in group  A re. in comparison to 8.71 ± 1.06 gm% 9.79 ± 0.07 gm% in group B respectively. No significant difference was seen in rise in Hb, MCHC, serum iron and serum ferritin and fall in TIBC in treatment while significant increase in MCV, MCH within both the groups post treatment. Mean duration for improvement in Hb by 1gm% in group A was 5.850 ± 0.983 days post-treatment while 12.390 ± 1.528 days in group B. Conclusion We noticed that mean duration required for improvement in haemoglobin level by 1gm%  in group A was significantly lesser i.e. 5.850 ± 0.983 days following treatment than mean duration in group B was 12.390 ± 1.528 days ( p < 0.001).

The burden of cardiovascular disease has steadily increased in India. The aim of this study was to examine the veins when they are harvested in patients undergoing CABG (coronary artery bypass grafting), prior to grafting, to look for early evidences of damage due to inflammatory processes & also for immunohistochemical evidence of inflammatory markers and to compare the findings in diabetic patients and non-diabetic patients. Materials And Methods: This study was as part of an Extramural Ad-Hoc ICMR funded project. After obtaining an informed consent, a total of 154 patients were enrolled.All patients underwent CABG & saphenous vein (SV) was harvested,sent to the lab for evaluation. The characteristic histopathological features were observed,the findings compared in both groups. Immunohistochemical evidence of inflammatory markers in the SV wall was looked for and staining for MMP-9, COX-2 and iNOS was evaluated. Florescent staining of the SV for alterations in the basement membrane was also done. Results: A predominant male population was observed with 61.68% diabetics, hypertension and hypercholestraemia were the major risk factors along with smoking. Subendothelial edema was the major histopathological finding seen. IHC staining for inflammatory markers MMP-9 and COX-2 was done and showed positive findings for both the inflammatory markers, Examination florescent staining was carried out to delineate the basement membrane. Fragmentation of the basement membrane with disruption and a fibrillary appearance was seen in patients with smoking and hypertension. A fragmented & homogenous / afibrillar basement membrane was seen in the saphenous vein of patients with diabetes. Conclusion: We inferred that quicker attrition of the vein grafts may be anticipated in individuals with significant histological findings. Studies with a larger sample size will help to further validate these conclusions.

Background: Foetus in foetus is a rare benign congenital anomaly. It occurs in 1 in 5,00,000 live births and almost < 200 cases are recorded so far1.. In FIF a malformed vertebrate foetus gets incorporated in living twin and presents as an abdominal mass with pressure effects. It is seen in Monozygoticmonochorionic diamniotic twins due to defect in embryo-pathogenesis causing asymmetrical division of blastocyst and malformed one draws blood and grows within live foetus. This benign condition mostly presenting in infancy or early childhood has to be differentiated from Teratoma with malignant transformation. Case presentation: A case of 10 days old female baby was brought by her mother with complaints of abdominal distension and excessive crying. The Ultrasound and CT scan of abdomen revealed, Extra gonadal teratoma.Serum levels of Alfa fetoprotein, Beta HCG(Human Chorionic Gonadotrophin) and CEA (Carcinoembryonic antigen) levels were found to be within normal limits. After surgical removal, specimen was sent for histopathological examination. Grossly mass was covered with glistening sac.On cut section,well-formed limb buds with fingers were noted along with different structures of variable consistency leading towards suspicion of Foetus in foetu. Microscopic appearance showed mature elements of epithelial and mesenchymal origin. Conclusion: Foetus in foetu is a rare anomaly and requires histopathological evaluation for well- aimed follow up as it has increased potential of malignant transformation.

Introduction: End-stage renal disease (ESRD) patients who need long-term hemodialysis often have dialysis fistulas created. Due to their long-term patency, high flow rates, and ability to be cannulated repeatedly, arteriovenous fistulas (AVFs) are the preferred access method. AVF creation connects an arm artery and vein to increase blood pressure and flow to the vein, which widens for hemodialysis. DUS (Doppler ultrasound) is the only diagnostic imaging method that simultaneously displays an area's anatomy (B-mode imaging) and blood supply (Color and Doppler imaging). Material and methods: The study was conducted on 40 patients at a department of surgery in central India from January to December 2022. Patients were divided into two groups: one with preoperative color doppler and the other based on clinical findings alone. Measurements were taken using the Aloka Prosound α-10 duplex machine, with the cephalic vein and brachial and radial arteries being measured. Result: 19 males and 21 females in Group A and 56.1 in Group B were enrolled. The study compared vascular access surgery patients with and without preoperative Doppler ultrasound scans. Age, sex, smoking status, and residence did not differ between groups. Vascular access was significantly different between the two groups. Group A had 75% left upper limb VA and 25% contralateral VA, while Group B had 65% left upper limb VA and 35% contralateral VA. Both groups had mostly urban non-smokers. Both groups had the most comorbidities: hypertension and hypercholesterolemia. Preoperative Doppler ultrasound scans improved vascular access surgery vessel selection. DUS and surgery showed significant differences in artery and vein diameter. DUS and clinical evaluations yielded 14 and 11 mature AVF, respectively. 12 DUS-functional and 8 clinical-functional. Statistical difference. DM and HTN comorbidities increased failure rate. Conclusion: The study analyzed the impact of preoperative duplex mapping for arterial and venous system and found that it reduces the failure rates in AV access surgery. The study compared the outcomes of AV access surgery based on clinical versus duplex method and found that the duplex method had a lower failure rate. The causes of early failure rates were also examined. The study identified the risk group that requires definite preoperative duplex mapping, which includes patients over 50 years old, female patients, and patients with comorbidities. However, the measurement by duplex scan is subject to operator-dependent errors.

Background: Thyroid dysfunction is the second most prevalent medical disorder which has impact on reproductive health and pregnancy outcome. Because of the link of thyroid auto antibodies with various pregnancy related complications and antithyroid peroxidase antibody (TPO Ab) being most common of all of them, can be used as a surrogate marker for thyroid related adverse pregnancy outcomes. Hence, this present study is designed to further elucidate any association of TPO Ab and TSH levesl with adverse pregnancy outcomes. Aims: The present study was undertaken to determine pregnancy outcomes between TPO Ab positive and negative hypothyroid mothers. Methods: This hospital based observational study was conducted in the Department of Gynaecology and Obstetrics, Raiganj Government Medical College, Uttar Dinajpur, West Bengal, India. 305 hypothyroid pregnant women at 1st trimester were chosen randomly between 1st June 2021 to 31st May 2022. The data was tabulated in Microsoft Excel software and analysed with SPSSV.20 software. Results: Maximum participants belonged to age group 15-20 years i.e. 115 (37.7%), followed by 21-25 years’ age group, 92 (30.2%) Mean age of the participants was 23.30 years. Mothers with high TPO were 127 (41.6%). In our study 74 (24.3%) mothers required 25 mcg Levothyroxin followed by 12.5 mcg required for 58 (19%) mothers. GDM (27.78% vs 12.29%, p <0.001), were significantly higher in TPO Ab positive than TPO Ab negative hypothyroid mothers. Conclusions: Pregnant women with hypothyroidism and positive TPO Ab status were more predisposed to GDM than TPO Ab negative women.

Introduction: Osteoporosis represent a continuum of conditions that present with a decrease in bone mass and disrupted bone microarchitecture most commonly as a result of increased age, menopause and metabolic abnormalities. Diagnosis is made with a DEXA scan having a T-score of >2.5 standard deviations below the peak bone mass of a 25 year old individual. Fracture risk assessment tool (FRAX) is another online tool which is used for probability of neck of femur fracture in an individual upto 10 years. Materials and methods: 806 patients of age group from 40 years to 90 years were selected for the study. 388 were male and 418 were female were included in the study. Bone mineral density was measured by DEXA scan at femoral neck and then FRAX score was calculated. Results: In our study, 20.9% of males and 17.2% females were osteopenic which were in the age group of 40 to 50 years. Incidence of osteoporosis was maximum in 7.2% males being in age group 40 to 50 years and 7.2% females in 51 to 60 years age group. Probability of major osteoporotic fractures was more in four females and there was no probability of osteoporotic fractures in males for upto 10 years. Conclusion: Development of the FRAX tool enables physicians working in primary health care to calculate the future risk of osteoporotic fractures in patients through the integration of a range of clinical risk factors with or without BMD measurements. Nevertheless, the FRAX tool should not replace the detailed clinical evaluation and additional clinical factors that are not currently included in the FRAX models.

Background: It is essential to determine the optimal treatment for intertrochanteric (IT) fractures due to their high incidence and related public health burden. Debate remains as to whether dynamic hip screws (DHS) or proximal femoral nails (PFNs) are best practices, and our study seeks to gather information relevant to this query. Methods: We undertook a retrospective audit of 90 patients in Rohilkhand Medical College between 2017 to 2021, who received a dynamic hip screw (Group A) or a proximal femoral nail (Group B) in order to compare age, sex, duration of surgery, blood loss, fluoroscopy time, functional outcome based on Harris hip score and radiological outcome was compared. Intraoperative and pre-operative data were collected from the record and patients were followed up for functional outcomes. Results: Out of 90 patients 45 (50%) patients were placed in each group. The average age of the patients was 64.43±17.17 years. Intraoperative blood loss in the PFN group(157.11ml) was significantly less compared to the DHS group (388.44ml), the mean duration of surgery in PFN group was 73.44min and 92.56min in DHS group(P<0.001), a shorter incision in PFN group compared to DHS group. The average limb shortening in both groups was not significant. The patients treated with PFN had better results than DHS when compared to Harris hip score. Conclusion: This study demonstrated PFN was found to be a better implant as compared to DHS, among patients undergoing intertrochanteric fracture fixation via PFN or DHS.

Background: India, like many other developing nations has seen a steady decline in pulmonary tuberculosis over the past decades due to successful implementation of RNTCP-DOTS programme nationwide and improvement in social & economic condition of the general population. It is now seen that extra-pulmonary presentations form a major proportion of new cases. A majority of them present as head and neck tuberculosis (TB) - tubercular cervical lymphadenopathy. In spite of advent of newer diagnostic tools like nuclear ploidy, genetic analysis, nuclear scan and so on, Ultrasonography (USG) being the simplest, quickest and non-invasive diagnostic modality with high sensitivity has gained a very significant place in clenching early diagnosis of neck nodes. Aims & Objectives To calculate the Sensitivity, Specificity & Predictive Accuracy of USG in diagnosis of Extra Pulmonary Tuberculosis (EPTB) when presenting as cervical lymphadenopathy. Material &Methods A prospective, cross sectional study was conducted for 12 months in a Medical College and Hospital among the patients attending the ENT, Surgery, Paediatrics and Medicine OPD & IPD with cervical lymphadenopathy. After estimating the sample size,172 patients were included in this study. After obtaining approval from the IEC and informed consent of the participants, they were selected according to the inclusion and exclusion criteria. Result The Sensitivity and Specificity of USG in reference to TB cervical lymphadenopathy were 91.43% and 84.38% respectively with a positive predictive value of 96.24% and negative predictive value of 69.23%. 15.63% were false positive and false negative were 08.57%. Conclusion USG is an effective, non-invasive, inexpensive and safe tool with a high Sensitivity which can become an important and integral screening modality in the diagnosis of Extra Pulmonary Tuberculosis.

Background: Oneof the common medical complications of pregnancy are hypertensive disorders which contribute significantly to maternal and perinatal morbidity and mortality.Hypertensive disorders in pregnancy are responsible for 76,000 maternal and 50,0000 infants death each year worldwide. There is growing evidence indicating that the risk of preeclampsia is increased in women with elevated levels of triglycerides and oxidized low-density lipoproteins. So, this study is designed to evaluate the changes in lipid profile that develops during normal pregnancy and pregnancy induced hypertensions. Objective: To estimate and compare the levels of lipid profile in pregnancy induced hypertension cases and controls. Method: The present study was a case-control study. It was conducted in Department of Biochemistry in collaboration with Department of Obstetrics and Gynecology, SHKM, Government Medical College, Nuh, Haryana. A total of 180 pregnant females were enrolled for this study of age 18 to 45 years (reproductive age group). We collected 5 ml of fasting venous blood sample and analyzed it for lipid profile.Mean and standard deviation of lipid profile and its severity in pregnancy induced hypertension patients Results: Total Cholesterol was highest in Eclampsia Group (294.57±23.74 mg/dL), followed by severe preeclampsia Group (252.03±9.63 mg/dL), and then in mild preeclampsia Group (214.37±12.63 mg/dL) and was least in control Group (159.12±15.28 mg/dl). Triglyceride was highest in Eclampsia Group (235.10±37.61 mg/dL), followed by Severe preeclampsia Group (190.23±10.67 mg/dL) then in mild preeclampsia Group (170.10±9.07 mg/dL) and was least in control Group (138.24±10.10 mg/dl). LDL-C was highest in Eclampsia Group (208.78±20.67 mg/dL), followed by Severe preeclampsia Group (175.59±9.16 mg/dL), then in mild preeclampsia Group (139.38±11.20 mg/dL) and was least in control Group (82.10±9.89 mg/dl). HDL-C was lowest in Eclampsia Group (38.77±3.92 mg/dL), followed by Severe preeclampsia Group (38.40±2.65 mg/dL), then in mild preeclampsia Group (42.30±2.90 mg/dL) and was highest in control Group (49.38±6.21 mg/dl). Conclusion: Lipid profile is deranged in pregnancy induced hypertension and is correlated with severity.

Background: Ophthalmic surgery is a common procedure in pediatric populations, and anesthesia is used to ensure patient comfort and safety during the surgery. The aim of this study was to compare the efficacy and safety of topical anesthesia and peribulbar block as an adjuvant to general anesthesia in children undergoing ophthalmic surgery. Objectives: The study aimed to evaluate the differences in hemodynamic changes during surgery, pain relief during and after surgery, and the duration of postoperative pain relief between the two anesthesia techniques. It also aimed to examine the occurrence of ocular-cardiac reflex and changes in intraocular pressure. Methodology: A randomized control study was conducted with two groups, Group GA-PB, consisting of general anesthesia with peribulbar block, and Group GA-TA, consisting of general anesthesia with topical anesthesia. The study population consisted of 50 children aged 2 to 12 years. The primary outcome measures included differences in intraoperative hemodynamic changes, the need for pain relief during and after surgery, and the duration of postoperative pain relief. The secondary outcome measures included the occurrence of ocular-cardiac reflex, incidence of postoperative nausea and vomiting, and changes in intraocular pressure. Results: There was no significant difference in age and weight between the two groups. The mean preoperative and intraoperative intraocular pressure did not differ significantly between the two groups. The GA-PB group showed significantly lower heart rate during surgery and required less pain relief during and after surgery. The duration of postoperative pain relief was also longer in the GA-PB group. There were no significant differences in oxygen saturation, blood pressure, incidence of ocular-cardiac reflex, or changes in intraocular pressure between the two groups. Conclusion: The study concluded that peribulbar block as an adjuvant to general anesthesia was more effective in reducing pain during and after ophthalmic surgery in children. It also showed that peribulbar block did not have any adverse effects on hemodynamic changes, oxygen saturation, or intraocular pressure. Therefore, peribulbar block can be considered as a safe and effective option for anesthesia in pediatric ophthalmic surgeries

Stroke is an abrupt onset of a neurological deficit attributable to a focal vascular cause. Globally, it is one of the leading causes of death and disability-adjusted life-years (DALYs) as per the estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (1).Red blood cell distribution width (RDW) may be a potential biomarker of inflammation in patients with stroke. Elevated RDW is associated with higher incidence of stroke, unfavourable functional outcome, and increased mortality(2). Aims and objectives of this study are to study the RED CELL DISTRIBUTION WIDTH in relation to stroke in Medicine department and to correlate the severity of stroke with RDW in patients of acute ischemic stroke. This was an observational cross sectional study conducted at Mallareddy hospital , in which 50 patients with acute stroke were included in study. Red cell Distribution Width(RDW) was measured for cases and patients were divided into four groups  - minor, moderate, moderate to severe, severe stroke based on NIHSS. RDW was measured for patients and compared among the four groups. Data collected was entered into MS EXCEL and analysed with IBM – SPSS version 20.0, p value, chi square test was done and its significance noted. In our study, mean age group is 56.04 years. About 70% are male and 30% are female. About 32% belong to NIHSS grade minor, 24% belong to moderate, 18% belong to moderate to severe, 26% belong to severe grade. The mean RDW in the patients with minor stroke was 38.06, moderate stroke was 45.04, and moderate to severe stroke was 47.42 and with severe stroke was 51.47 (p < 0.001).

Introduction: Vitiligo is an acquired pigmentary anomaly of the skin. It is manifested via de-pigmentary white patches on the skin with normal border or surrounding hyperpigmentation. Over the recent years, vitD (vitamin D) is implicated in a wide variety of medical conditions. It functions like a hormone and is produced in the skin where it plays an important role in skin pigmentation, increase enzyme action of tyrosinase and thus also affects melanin production. It also displays various immunoregulatory functions. VitD is found to be reduced in autoimmune diseases, like SLE, DM, alopecia areata, RA and multiple sclerosis.  Materials and methods: This is a prospective and case-control study was conducted. 120 vitiligo patients attending Department of Dermatology at R V M. Medical College, were included over a period of 6 months. Full history and examination were done, and the diagnosis was confirmed clinically and by using Wood’s light examination. In addition, 100 controls, age and sex matched, were included for comparison. Patients with vitiligo (generalized, focal, or segmental), normal thyroid function tests, and serum vitamin B12 were included in the study. In addition, clinical details of vitiligo were obtained including patient demographics, duration of vitiligo, and current and previous treatment.  Results: The demographic data of the 60 patients with vitiligo participating in this study. Comparison of mean VASI score calculated before and after treatment shows that the overall VASI score was significantly decreased relative to baseline (P<0.001).  Conclusion: Further studies are required to establish a causal relationship between vitiligo and vitD and likewise exploring the possibilities of use of vitD in treating vitiligo either alone or in combination with other therapies. The findings suggested there is no convincing evidence that vitamin D may help to prevent vitiligo.

Introduction: Diseases of the gallbladder have been recorded in humans since antiquity, with gallstones found in the mummy of princess Amenen of Thebes dating to 1500 BCE. Some historians believe the death of Alexander the Great may have been associated with an acute episode of cholecystitis. Aims: To look into the Spectrum of Bacterial Agents in Bile contents Of Patient Undergoing Cholecystectomy and Antibiotic Sensitivity Pattern. Materials and method: A Cross Sectional study was conducted with Prior Approval from Ethical Committee of AGMC & GBPH, AGARTALA. The study duration was January 2021 to July 2022. 187 patients were included in this study. Result: In our study, Bactibilia was found in 27/50 (52%) of patients. Polymicrobial flora was found in 10% of bile samples. Escherichia coli, Klebsiella pneumoniae and Enterococcus faecalis were the predominant organisms isolated. None of the anaerobes were isolated. Extended spectrum β-lactamase and AmpC β- lactamase (AmpC) production was seen in 47% and 31.5% of Enterobacteriaceae isolates respectively. Post-operative wound infection was found in six (12%) patients who had bactibilia. Conclusion: we concluded that, the valuable information regarding the bacteriological profile and the antimicrobial susceptibility pattern in patients undergoing cholecystectomy and admitted in AGMC and GB Pant hospital. This information can be used in formulating empirical antibiotic guidelines in patients admitted in AGMC and GB Pant hospital and planned for cholecystectomy.

Background: Fine Needle Aspiration Cytology (FNAC) is a simple, minimally invasive, cost effective, outpatient based and a rapid diagnostic method for breast lesions. The aim is to determine the accuracy with the benign and malignant lesions can be differentiated by fine needle aspiration cytology (FNAC) and to correlate the findings with histopathological diagnosis Material and Methods: It is a prospective study comprising of 105 patients of breast lumps who underwent FNAC followed by histopathological examination. All the breast lump aspirates were stained with Haematoxylin and Eosin (H and E) stain. Results: Among total majority of the patients (29.5%) belong to 31-40 years age group. Benign breast lesions were found in 65.8%, among which fibroadenoma (40.9%) was the commonest lesion which was observed. Malignancy was observed in 34.2%; among them, ductal carcinoma was the predominant lesion (18.1%) which was seen. Breast lump lesion was more in right side (54.3%) than left breast. Conclusion: The most common benign tumor in the present study was fibroadenoma and the most common malignant tumor was invasive ductal carcinoma.

Background- The purpose of this study was to assess the effectiveness of oncoplastic surgical management for benign phyllodes tumour. Methods- Patients (n = 37) with eligible breast benign phyllodes tumour underwent oncoplastic surgical management. Primary outcome measures included, postoperative recurrence, and intra-operative and postoperative complications. Results-Thirty-seven patients who underwent surgical excision and oncoplastic breast surgery. The age range of the patients was 42 to 58 years. The majority of breast lesions were between 5 and 10 cm in size, ranging in size from 3.5 to 12.5 cm. On the seventh post-operative day, 56.8% of patients reported pain at the surgical site, 10.8% of patients had seroma, 5.4% had wound infections, 5.4% had flap necrosis, and 21.6% had lymphedema. Pain observed On Day 7 (56.8% of patients), there were 21 patients; on Day 21, there were 5 patients (13.5% of patients). There was a statistically significant difference in the proportion (P=0.001). Conclusions-Surgery and oncoplastic breast surgery are safe and effective for benign phyllodes tumours. Oncoplastic breast conservation surgery allows greater parenchymal resection without compromising oncology or aesthetics. Histopathological analysis pre-operatively reduces recurrences, reoperations, and oncologic outcomes. It can also prevent adjuvant therapy delays.

Background: To study the pattern and treatment outcome of secondary glaucoma in all age group of patients in a tertiary care hospital. Methods:This was a hospital-based prospective longitudinal study conducted on 70 patients of secondary glaucoma in a tertiary eye hospital of central India from January 2021 to June 2022. Demographic data was collected, detailed history was taken and a comprehensive ophthalmic examination was done in all patients. Results: The mean age at presentation was 61.08 ± 14.08 years with male to female ratio of 1.4:1. The most common cause was lens induced (LIG)in 45 (64.2%) followed by neo-vascular (NVG) in 7 (10%) and uveitic glaucoma in 6 (8.57%). Traumatic glaucoma was seen in 5(7.14%) cases while miscellaneous included 7 (10%). At presentation, the mean IOP was 37.87mmHg, being highest in NVG patients. Sixty four (91.4%) of patients had a presenting VA<6/60 in the affected eye. Forty nine (70%) patients regained VA better than 6/60 with maximum improvementbeing seen in LIG patients. Conclusion: Among different types of secondary glaucoma lens induced glaucoma was most common. Most patients were females, and majority presented with poor vision. NVG patients had the highest mean IOP. Best visual improvement after management was observed in LIG patients.

Introduction: Upper limb surgeries frequently use the brachial plexus block for anesthetizing the limb. The conventional approach by eliciting paresthesia is a blind procedure that may have a higher failure rate and  cancause damage to the nerves and nearby structures. Peripheral nerve stimulator and ultrasound techniques were introduced to aid in better localization of the nerve/plexus avoiding tissue damage. With excellent localization and increased safety margin, ultrasound has increased the success rate of supraclavicular brachial plexus block. The purpose of this study was to compare the effectiveness of a Peripheral nerve stimulator with Ultrasound for giving Supraclavicular brachial plexus block. Material and Methods: After obtaining the Institutional ethical committee approval and patient consent,a total of 60 patients were enrolled in this prospective randomized study which were randomly divided into two groups in whom Supraclavicular brachial plexus block was given using either  Peripheral nerve stimulator (Group PNS) or Ultrasound (Group USG). Both groups received 15 ml  0.5% Bupivacaine and 10 ml Lignocaine with Adrenaline {2%}[1;200,000]. The  chiefparameters considered were time of onset of sensory and motor block, duration of analgesia ,block failure and complications following block. Results:Demographic data was comparable in both the groups. The mean time of onset of motor block and sensory blockwas  found to be more in Group PNS as compared to Group USG.The duration of sensory and motor blockade was more in group PNS ascompared to group USG . The success rate of the block was higher in ultrasound group than  inPNSgroup however it wasstatisticallyinsignificant. No complications occurred in either group. Conclusion:Ultrasound guidance  is a safe and effective method for giving supraclavicular brachial plexus block with faster onset and more lasting duration of motor and sensory blockade.

Introduction- Hypertensive disorders of pregnancy constitute one of the leading causes of maternal and perinatal mortality worldwide, specially in developing nations with poor access to health facilities. An easy, cost effective and precise diagnostic algorithm needs to be developed for early detection of preeclampsia in order to reduce maternal and fetral mortality. There are also marked changes in the coagulation and fibrinolytic system occurs during normal pregnancy leading to hypercoagulable state. These changes are more magnified during eclampsia and preeclampsia. Coagulation activation probably represents a secondary event consequent upon endothelial activation and damage. Antithrombin which binds and inactivates thrombin correlates inversely with the level of proteinuria and subsequent renal dysfunction. aim And Objectives-To evaluate platelet parameters in prediction of preeclampsia, assess platelet indices namely platelet count (PC), mean platelet volume (MPV), platelet distribution width (PDW), and platelet large cell ratio (PLCR) in women with preeclampsia compared with healthy controls. Determine correlation between platelet count and platelet indices in preeclampsia patients and normal pregnancy,and assess coagulation parameters and LFT levels in women with preeclampsia and normal pregnancy. Materials And Methods- It is a Prospective Case Control study included women with pre-eclampsia and control study group included healthy normotensive pregnant women of age group between 18-35 years of more than 20 weeks gestation. Total 102 cases taken [51 preeclampsia patients and 51 healthy pregnant women] Results- The platelet count in preeclampsia was significantly lower than in normotensive control group. while all platelet indices were increased with preeclampsia with a statistically significant difference p value-0.00. Results also showed an increase in coagulation parameters and liver function variables in preeclampsia patients when compared with the control group. Conclusion-Pregnancy induced hypertension is a significant cause of maternal and fetal morbidity and mortality. The current study was undertaken to study about the platelet parameters and coagulation profile in early detection and prediction of severity of preeclampsia. We have compared multiple laboratory variables in women with preeclampsia with normotensive patients.

Introduction: Malaria continues to be one ofthe biggest health problems inthe Indian subcontinent with 95% of our population is living at risk of infection.Several common complications associated with this disease include anaemia, thrombocytopenia, hepatological changes causing deranged liver and renal function tests. Complication corresponds with the parasitic density determined microscopically. Aim: To study the relationship between parasitic density with haematological parameters, liver function test and kidney function tests. Material & methods: Total 52 malaria falciparum cases studied, diagnosis was by thick and thin smear preparation. Parasitic density was determined according to WHO criteria. Haematological parameters determined by smear microscopy. Liver function and renal function tests were performed by fully automated biochemistry analyser. Results: Out of total 52 cases mean haemoglobin level is 10.10gm%. serum ALT AST level increases with level of parasitemia. Renal involvement seen in later stage and only in moderate and high parasitemia. Conclusion: Malaria complications are directly proportional to the parasitic density and disease spectrum changes with level of parasitemia. Initially cerebral involvement is most common findings in falciparum cases but nowadays liver followed by kidney injury is becoming common presentation.

Introduction- Ovarian cancer is one of the ten most commonly diagnosed cancers in women and has the highest mortality rate and the worst prognosis of all gynecological cancers. In 2018, 295,414 cases of Ovarian cancer were detected worldwide, and 184,799 died, with the highest incidence in developed countries. The mortality rate has not changed in the past 30 years, and it is predicted that by 2040, this rate will be significantly increasing. Materials And Methods- Study based on proper clinical examination, radiological investigation, histopathological diagnosis and hematological investigations and Measurement of serum CA-125 and HE4 will be carried out by ELISA method. Results- out of 50 neoplastic lesions 31 cases are benign tumours, 02Borderline and 17 cases are malignant. Conclusion-We concluded High ROMA Index Value shows malignancy. Low value of ROMA index cases are benign so that ROMA Index is helpful to differentiate     in benign and malignant lesion preoperatively

Introduction: It is unknown whether the COVID-19 pandemic has had an impact on emergency surgical care worldwide. This study aimed to compare frequency, treatment strategies, severity, and complication rate of appendicitis during the COVID-19 pandemic with those of previous two years. Methods: In this single-center study, we identified all patients admitted with appendicitis, at the MYH Hospital, and compared these with patients hospitalized with appendicitis during the same calendar period the two previous years. Results: In all, 200 patients hospitalized with appendicitis were identified, 100 in Covid period group and the remaining 100 during the same calendar periods pre- Covid era group. Mean age was slightly increase during pandemic era, while the male female ratio 1.7 in precovid era while in covid era its 0.81. Fatality due to appendicitis during the COVID-19 period was seen four time than the pre covid period. Conclusions: COVID-19 gastrointestinal symptoms in children and adolescents resemble acute appendicitis and MIS. Abdominal pain, emesis, anorexia, and diarrhoea make acute appendicitis difficult to diagnose without preoperative imaging. The COVID-19 pandemic increased CT scan use to confirm diagnoses and reduce unnecessary surgery. After extensive research, analysis, and evaluation, COVID-19 did not affect complicated appendicitis. The above factor significantly delayed operative interventions. An extensive literature review shows that patient concerns about Covid-19 transmission reduced emergency department visits.

Introduction: Upper limb surgeries frequently use the brachial plexus blockade method. The conventional approach of treating paresthesia is a blind procedure that may have a higher failure rate and cause damage to the nerves and nearby structures. Peripheral nerve stimulator and ultrasound techniques were introduced to help with better localization of the nerve/plexus in order to avoid some of these issues. With excellent localization and increased safety margin, ultrasound has increased the success rate of supraclavicular brachial plexus blocks. The purpose of this study was to contrast the effectiveness of a Peripheral nerve stimulator with an ultrasound-guided technique brachial plexus block. Material and Methods: After obtaining the Institutional ethical committee approval and patient consent total of 60 patients were enrolled in this prospective randomized study and were randomly divided into two groups: Peripheral nerve stimulator (Group PNS) and ultrasound-guided technique (Group USG). Both groups received 0.5% bupivacaine. The amount of local anesthetic injected calculated according to the body weight and was not crossing the toxic dosage (injection bupivacaine 2 mg/kg). The parameters compared between the two groups were lock execution time, time of onset of sensory and motor block, quality of sensory and motor block success rates were noted. The failed blocks were supplemented with general anesthesia. Results: Demographic data were comparable in both groups. The mean time taken for the procedure to administer a block by eliciting PNS is less compared to USG, and it was statistically significant. The mean time of onset of motor block, sensory blockade, the duration of sensory and motor blockade was statistically significant. The success rate of the block is more in ultrasound group than PNSgroup which was not clinically significant. The incidence of complications was seen more in PNS group. Conclusion: Ultrasound guidance is the safe and effective method for the supraclavicular brachial plexus block. Incidence of complications are less as ultrasound provides real-time visulaization of underlying structures and the spread of local anaesthetic.

Background- Vast majority of fractures of distal radius are articular injuries that result in disruption of both radiocarpal and radioulnar joints. This article presents a percutaneous pinning technique.The purpose of this study is Prospective study on outcome of distal radial fractures treated with closed reduction and percutaneous pinning. Material and method - after ethical approval from IEC, 34 patients with AO type C radius fractures were treated by percutaneous pinning (K-wire) between 27th Aug 2021 to 31st October 2022. The follow up studies include clinical and radiographic examinations. Results- All 34 patients were assessed by follow ups using modified mayo score. The majority of study participants, or 55.90% (n=19), received good scores, while 29.40% (n=10) received exceptional scores. Only 2.90% (n=1) of respondents received a low score. Conclusion- Primary treatment of distal radius fractures is necessary to improve function and prevent complications from immobility. Closed reduction and percutaneous fixation with Kirschner wires alone are effective for distal radius complete intra-articular fractures. Closed reduction and percutaneous pinning patients with distal radius fractures had good range of motion, normal Mayo wrist scores, and no radiographic changes between fracture fixation and fracture healing.

Background: Pathologists are subjected to occupational hazards at work because they are medical professionals engaged in the diagnosis and planning of treatments for many diseases. Therefore, our goal was to identify the workplace health problems that pathologists and residents of pathology in Bihar were experiencing.Methods: A self-reported questionnaire about the main occupational health issues, such as musculoskeletal issues, visual disorders, workplace characteristics, health behavior, and other medical conditions, was used to gather the data for this cross-sectional research.Results: In this study, 400 individuals consisting of 215 pathologists and 185 residents of Pathology participated. 284 were men (71%), and 152 (38%) were younger than 35 years. 179(44.75%) and 91(22.75%) of pathologists reported working more than 5 hours with the microscope and computer, respectively. Our data showed that 337 participants (84.25%) experienced musculoskeletal pain, and the neck was the most commonly reported location of pain among study participants 239 (59.75%). A total of 300 (75%) participants reported visual refractive errors, and myopia was the most prevalent form of error among 204 (51%) participants. An overall history of acute injuries during work was reported in 289 (72.25%) participants, and the cutting injury was the most common type among 218 (54.50%) participants. As regards other medical conditions, depression was reported in 59 (14.75%) of the participants, followed by burnout 40(10.0%) and hypertension 15(3.75%). Workplace atmosphere was very good among 79(19.75%) participants, Good in 211(52.75%), Fair in 95(23.75%) and Poor in 15(3.75%) participants. Conclusion: We found that among pathologists and residents, health hazards such as musculoskeletal issues, visual disturbances, injuries, and ergonomic issues were very common. Comprehensive protection and prevention are required to address these issues, as well as educational initiatives that pay closer attention to workplace ergonomics and chemical and biological hazards.

Background: Addiction to the internet is becoming more common among teenagers, but very few studies conducted in India have examined and taken into account the numerous elements that may contribute to internet addiction in this at-risk demographic. We investigate the differences between adolescents with and without internet addiction in family functioning, temperament, character, and psychopathology. Methods and Materials: 2000 teenagers from urban middle-class families participated in this comparative cross-sectional study using a two-randomized group design. The participants for the clinical and control groups were drawn from high schools. Those having a serious internet addiction were contrasted with others who didn't have one. As a screening tool, the Internet Addiction Test, Temperament and Character Inventory, Devereux Scale of Mental Disorders, McMaster Family Assessment Device, and General Health Questionnaire were all administered. The statistical analysis was performed using Epi Info 7 edition. Result: Adolescents who were addicted to the internet had strong novelty seeking and low persistence. Depression and behavioural issues were also linked to internet addiction. Depression and years of internet use were significantly positively correlated. Families of young people with internet addiction have more trouble communicating, settling problems, controlling their behaviour, and being affectively attentive and involved. Conclusion: Study concluded that adolescents that use the internet excessively tend to have temperamental issues, increased psychopathology, and unstable households. Family-centered techniques for managing internet addiction must be addressed because families are so important in Indian culture.

Background: Second-generation supraglottic airway devices (SADs) are used in routine cases or when encountered with a difficult airways. This study was done to compare the ease of blind endotracheal intubation using I-Gel versus the Blockbuster Laryngeal Mask Airway (LMA) in female patients posted for laparoscopic cholecystectomy under general anesthesia. Materials and methods: This study was a randomized, prospective, double-blind and controlled in which included Ninety, American Society of Anaesthesiologists (ASA) I-II and Mallampatti class (MMC) 3-4, female patients aged between 18-60 years and were divided into two groups. Each Group A and B had 45 patients, in whom blind endotracheal intubation was attempted through the I-Gel and Blockbuster LMA respectively after induction of anaesthesia. The time required for insertion, ease of insertion, number of attempts, maneuvers applied, and time for intubation, intubation success rates, intraoperative hemodynamic parameters during the procedure along with postoperative complications thereafter were documented and compared. Results: Time required for placement was less and ease of insertion better with Blockbuster LMA as compared to I-Gel. Duration for tracheal intubation was reduced and the overall rate of successful intubation was higher (96.9%) with Blockbuster LMA than I-Gel (80%). Fewer hemodynamic changes with minimal post-operative complications were seen with the Blockbuster LMA. Conclusion: It was concluded by the study that both I-Gel and Blockbuster LMA can be used as a channel for conducting endotracheal intubation, the overall success rate was higher with the Blockbuster LMA with minimal complications.

Since students must take theory, clinical, and practical courses in a range of subjects, including anatomy, physiology, biochemistry, community medicine, etc., the MBBS curriculum is more demanding and challenging. In a brief period of time. Students often experience stress as they discover novel ideas and theories that are used in clinical settings. Since they are fresh to the subject, first-year MBBS students are undoubtedly a little stressed. One hundred first-year MBBS students were chosen for the study using a survey. Students studying medicine completed a survey. In this study, we looked at how much more stress female students take on in terms of academic stressors, interpersonal and intrapersonal stressors, teaching and learning stressors, and social stressors.

Background: COPD is a leading cause of morbidity worldwide, particularly in developing countries. Heart is the most targetable organ for COPD as systemic complication. The cardiac manifestations of COPD are directly due to pulmonary arterial hypertension and the development of Cor Pulmonale. Objective: To estimate the prevalence of electrocardiographic changes in the COPD  patients and their relation with increasing severity of COPD.  Methods: This hospital Based Cross Sectional Study was conducted in Department of Medicine, Tertiary care centre among Patients of COPD who presents to our hospital during study period.  Results: Most common ECG abnormality was arrhythmia among COPD cases (46.5%) followed by RAD – P wave (46.5%) and p-pulmonale (32.6%). Gender distribution was comparable among cases with and without ECG changes (p-0.147). No association was observed between presence of ECG changes among COPD cases with its duration (p-0.112). A significant association was observed between ECG changes in COPD cases with its severity. A significant association was observed between ECG changes in COPD cases with severity of symptoms. Prevalence of ECG changes increases from 39.5% in CAT gare A to 100% in grade D (p<0.01). Conclusions: ECG abnormalities, were common in cases of COPD, affecting seven out of ten cases and have a significant association with COPD and symptoms severity. The most common electrocardiographic abnormality seen was arrhythmias.

Introduction: Normal parturition at term is dependent on the programmed development of the cervix early in pregnancy. The cervix undergoes preparative changes weeks before the onset of labour. It is well known that a reduced midtrimester cervical length is associated with an increased risk of spontaneous preterm birth. Aims: The present study was undertaken to delineate the cervical changes in cases that will end up in preterm delivery from cervical changes that ends in term delivery. Methods:  This hospital based observational study was conducted in the Department of Obstetrics & Gynaecology of Burdwan Medical College and Hospital, Burdwan, West Bengal, India. 173 cases were chosen randomly after applying inclusion and exclusion criteria after having proper consent of the mothers. The duration of the study was 18 months (year 2022-2023). The data was tabulated in Microsoft Excel software and analysed with SPSS V.24   software. Results: The mean maternal age was 26.68±4.10 years in patients with preterm labour and 26.45±3.36 years in patients with term labour .A total of 173 patients were included in the study among them 16.2% had preterm delivery and 83.8% had term delivery. Majority of the patients with preterm labour (75%) were from the age group of 20- 30 years. Among the patients with preterm labour, majority (60.7%) was nulli para. Among the patients with preterm labour, majority (71.4%) was primi gravida and among the patients with term labour, majority (75.2%) was primi gravida. Among the patients with preterm labour, 82.1% was normal, 7.1% was underweight and 10.7% was overweight. Conclusions: Prediction of preterm labour by suitable effective and reliable method is a boon to save innumerable young lives. By reducing preterm deliveries, we can manage huge economic, medical and social burden on the country as well as the globe.

Introduction: Normal parturition at term is dependent on the programmed development of the cervix early in pregnancy. The cervix undergoes preparative changes weeks before the onset of labour. It is well known that a reduced midtrimester cervical length is associated with an increased risk of spontaneous preterm birth. Aims: The present study was undertaken to delineate the cervical changes in cases that will end up in preterm delivery from cervical changes that ends in term delivery. Methods:  This hospital based observational study was conducted in the Department of Obstetrics & Gynaecology of Burdwan Medical College and Hospital, Burdwan, West Bengal, India. 173 cases were chosen randomly after applying inclusion and exclusion criteria after having proper consent of the mothers. The duration of the study was 18 months (year 2022-2023). The data was tabulated in Microsoft Excel software and analysed with SPSS V.24   software. Results: The mean maternal age was 26.68±4.10 years in patients with preterm labour and 26.45±3.36 years in patients with term labour .A total of 173 patients were included in the study among them 16.2% had preterm delivery and 83.8% had term delivery. Majority of the patients with preterm labour (75%) were from the age group of 20- 30 years. Among the patients with preterm labour, majority (60.7%) was nulli para. Among the patients with preterm labour, majority (71.4%) was primi gravida and among the patients with term labour, majority (75.2%) was primi gravida. Among the patients with preterm labour, 82.1% was normal, 7.1% was underweight and 10.7% was overweight. Conclusions: Prediction of preterm labour by suitable effective and reliable method is a boon to save innumerable young lives. By reducing preterm deliveries, we can manage huge economic, medical and social burden on the country as well as the globe.

Background: For inhibition of treatment failure, clinical microbiology laboratories should be able to detect methicillin-resistant Staphylococcus aureus (MRSA) more precisely and rapidly. The aim of this study was to detect MRSA from various clinical samples by using two different phenotypic methods (cefoxitin disc diffusion method and CHROMagar method) in order to determine which method produced the best phenotypic results as well as to observe the organisms' resistance pattern. Method: S.aureus was identified in this study with the use of traditional methods for various clinical samples. Cefoxitin disc diffusion, MIC (by Vitek 2), and MRSA CHROMagar were used to screen all isolated strains of S. aureus for methicillin resistance. S.aureus ATCC -25923 strains was used for the purpose of quality control. Kirby Bauer's disc diffusion method was used to test antibiotic sensitivity in accordance with CLSI guidelines.  Result: Present study showed that 61 (38.6%) MRSA were detected out of total 158 S. aureus isolates by cefoxitin disc diffusion method and CHROMagar method. Turnaround time(TAT) for quick  identification of MRSA  by cefoxitin disc diffusion method was found to be  48 hours  for 36.1% MRSA, whereas  MRSA detection was quite fast  i.e.,  for 95.1% of MRSA in 24 CHROMagar method. All MRSA isolated from various clinical specimens were susceptible to vancomycin and linezolid. Conclusion: The most accurate method for detection of MRSA is cefoxitin disc diffusion, but it has disadvantage of time consuming process. A one-step CHROMagar method may also be considered as a better option for routine and rapid screening of MRSA from clinical samples.

Introduction: Second-hand smoke is formed from the burning of smoking products and the smoke exhaled by the smokers. Worldwide, a large proportion of children, male and female non-smokers are exposed to the second-hand smoke at home. Exposure to second-hand smoke resulted in the occurrence of several diseases such as ischaemic heart disease, lower respiratory infections, asthma and lung cancer, and even death. With the growing scientific evidences for the hazard of Second-hand smoke, many countries have taken stringent action to reduce Second-hand smoke exposure through legislation and health education, and have achieved significant improvements. Materials and methods: This is a prospective and cross-sectional study conducted in the Department of Community Medicine at Tertiary Care Teaching Hospital over a period of 1 year; we objectively assessed SHS exposure concentrations. A predesigned, pretested semi structured interview schedule was prepared and translated into the local language. We used two measures of SHS: exposure to SHS at home and exposure to SHS in the workplace. SHS exposure at home is estimated for non-smokers who reported anyone smoking inside his/her home. Exposure to SHS in the workplace is estimated for non-smokers who reported anyone smoking in the workplace in the past 30 days before the survey. Result: In this study shows the demographic predictors of SHS at home and workplace. At home and workplace, the SHS exposure was higher among male (89%) as compared to female (11%), whereas at home, the SHS exposure was higher among male (82.5%) as compared to female (17.5%) and at workplace, the SHS exposure was higher among male (90.9%) as compared to female (9.1%). Distribution of Age group of persons exposed to second‑hand smoke at home and workplace, the exposure was highest in 25–44 years old (52.7%) while lowest years old have exposure to SHS as compared to other age group categories. Distribution of Residence of persons exposed to second‑hand smoke at home and workplace at urban area (62.7%) as compared to rural settings (37.2%). The high-grade education category was (30.9%) had the highest exposure to SHS at the workplace in contrast to other categories. The Retired and unemployed occupation category (3.6%) had the highest exposure to SHS analogous to other occupation categories. Conclusion: Current smoking and exposure to second-hand smoke among internal migrants in India is high. Socio-demographic characteristics and migration status were strongly associated with current smoking and second-hand smoke exposure. We recommend specifically targeted tobacco control interventions to help to address these risk factors.

Background: This study was conducted to evaluate the role of ultrasound elastography in differentiation of solid breast masses, to calculate the elasticity score and strain ratio of all solid breast masses, and to determine the sensitivity and specificity of ultrasound elastography in differentiating between benign and malignant breast masses. Methods: This was a hospital based prospective diagnostic analytical study, conducted among 50 female patients who presented with solid breast masses to the Department of Radiodiagnosis, VIREC, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur, Odisha, over a period of 2 years, from November 2019 to October 2021 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: There was strong evidence of relationship, found between BI-RADS interpretation and histopathology interpretation (p<0.0001), radiological interpretation and histopathology interpretation (p<0.001), and interpretation of Tsukuba score and histopathology interpretation (p<0.0001). Diagnostic significance of ES in class 2 lesions was shown to have a significant association between histopathological interpretation and ES. (P<0.001). Diagnostic significance of Tsukuba score in lesion with largest diameter (mm) >20 mm was assessed. A significant association was noted between histopathological interpretation and Tsukuba score (p<0.0001). In association of Tsukuba score with histopathological diagnosis, significant difference in frequency distribution was observed (p<0.0001) indicating a higher frequency of malignant lesion in subjects with a higher Tsukuba score. Conclusion: B-mode sonography which is well known for its high sensitivity but poor specificity, in combination with qualitative sonoelastography with high specificity, may increase diagnostic performance when differentiating between benign and malignant breast masses. Sonoelastography works best in combination with B-mode sonography and thus represents a technologically advanced extension of the same.

Background: The study was conducted to evaluate the use of dynamic contrast magnetic resonance imaging as a modality to identify various lesions in pituitary gland and sella, characterize and document various enhancement pattern of pituitary lesions with clinical and histopathological correlation and compare non contrast MRI vs dynamic contrast MRI in evaluating pituitary lesions. Methods: This was a hospital based cross sectional study conducted among 30 patients who presented with pituitary dysfunction to the Department of Radio-Diagnosis and Imaging, Government General Hospital, Kurnool Medical College (KMC), Kurnool, from November 2019 to November 2021 after obtaining clearance from institutional ethics committee and written informed consent from the study participants. Results: Neoplastic lesions are the most common type of pituitary lesions. Pituitary adenomas were mostly found in females. Macroadenomas were more common than microadenomas. The most common clinical feature of macroadenoma was headache. The most frequent cystic lesions were macroadenomas, Macroadenoma constituted the most cases which showed blooming on SWI. In dynamic contrast enhancement pattern, majority of cases show homogenous enhancement and least common pattern was rim enhancement. MRI majority of cases enhance between 0 to 60 seconds (early phase) and (16.6%)% of cases enhance between 60 to 200 seconds (late phase). Among microadenomas, 83.3% enhance in late phase of dynamic study.  Whereas in MRI diagnosis vs. histopathology diagnosis, out of 13 MRI diagnosed Macroadenoma, 1 case turned out to be sellar meningioma. Out of 4 MRI diagnosed craniopharyngioma, 1 case turned out to be Rathke cleft cyst. Conclusion: Knowledge of the normal anatomy and pathologic imaging appearance of sellar lesions is essential in the interpretation of MR imaging of brain and pituitary. The wide spectrum of sellar masses often present with similar symptoms. Accurate imaging characterization and early diagnosis are capable of providing significant clinical benefits.

Background: A stroke or Cerebrovascular accident is defined as an abrupt onset of neurologic deficit that is attributable to a focal vascular cause. Infections and inflammation play a vital role in the pathophysiology of atherosclerosis. Objective: To estimate and correlate levels of high-sensitivity C-reactive protein in acute ischemic stroke. Methods: This Observational Case-Control Study was conducted in the Government Medical College, Nagpur in Central India. The duration of the study was 2years. 51 patients who were diagnosed with the First ischemic stroke were included in the study. Results: The mean HsCRP of the cases was 4.2±1.4 years and the mean HsCRP of the controls was 1.6±1.2 years. There was statistically significant difference. The patients who survived had NIHSS score 16±3.0 on admission and 12±3.0 on discharge. The patients who did not survive had NIHSS score 30±1.5 on admission.The size of the infarct was found to be increasing with the increase in hsCRP levels. Te size of the infarct was like, 1.92 cm² in hsCRP<3; 18.55 cm² in hsCRP 3-8; 24.60 cm² in hsCRP 9-14; 36.54 cm² in hsCRP 15-20 and 51.25 cm² in hsCRP>20. Conclusions: HsCRP levels are independent risk factor in Acute Ischaemic Stroke patients without infection, as well as for in-hospital mortality. Also, higher level of serum HsCRP is associated with increased neurological deficit assessed by NIHSS and poor outcome.

Background: Acute Coronary syndrome (ACS) in diabetic patients is associated with an increased overall risk of stent thrombosis compared to the general ACS population. In many centers worldwide the routinely used antiplatelet agent in most settings is still clopidogrel. It is generally recognized that many patients exhibit a diminished response to Clopidogrel. The study aimed to verify whether clopidogrel response measured by MEA in response to ADP, in diabetic ACS patients treated with PCI predicts the risk of stent thrombosis and bleeding. Methods:  In this prospective observational study, consecutive diabetic patients admitted with ACS who were treated by successful PCI with stent implantation and started on Clopidogrel as a second antiplatelet agent were included. ADP-induced platelet reactivity assessment was performed directly before patient discharge using a Multiplate electrode analyzer with ADP as an inducer. The cutoff value for high platelet reactivity was considered as greater than 468 AU * min and less than 188 AU * min for very low platelet reactivity, based on the consensus of the Working Group On treatment platelet reactivity. Results:  Out of n=100 members included in the study most of the patients were having single vessel disease (62%) and 38% had double vessel disease. 30% of the study population showed high platelet reactivity and 14% were having low platelet reactivity. Stent thrombosis developed in 6% of patients, of which 4% had definite stent thrombosis and 2% had probable stent thrombosis. Out of n=6 patients with stent thrombosis, 4 cases showed high platelet reactivity with an odds ratio of 5.23 (0.90-30.29) and a P value of 0.0064. N=8 patients developed bleeding of which 2 were major and 6 minor. Out of n=8 patients with bleeding n=4 cases were having low platelet reactivity with an odds ratio of 6.538 (0.38-111.09) with a P value of 0.001 which was statistically significant for major bleeding Conclusion: This study shows that in a high-risk population of patients with ACS and diabetes treated with stent implantation and receiving clopidogrel, higher on-treatment platelet reactivity (HPR) is related to increased risk of stent thrombosis and low platelet reactivity (LPR) to increased risk of bleeding at 1-year follow-up.

Introduction: Over the recent decades more & more pregnant women around the world have been undergoing induction of labor for the safe termination of their pregnancies. Numerous factors determine the success of induction- it depends on term or near term gestation, BISHOPS score of 5 or less, cervical ripening, maternal pelvis and fetal weight. .Although there are various methods of induction available including medical, surgical mechanical methods; the most effective & safest approach for a safe & timely delivery is not yet known & hence requires further research. This study has been conducted by combining mechanical method of induction –Foleys catheter with a medical method- misoprostol to utilize their additive effect to achieve a safe & timely delivery. Aims & Objectives: Primary Objective: To compare the time from induction to active phase & induction to delivery in induction of labor with a combination of Foley’s catheter followed by misoprostol with only misoprostol. Secondary Objective: To compare the maternal complications of labor induction & to assess the fetal outcome. Methodology: A Quasi Experimental Study including 50 patients in each group was done after satisfying the inclusion & exclusion criteria .Group A included induction with Foley’s catheter followed by misoprostol & Group B included induction with misoprostol alone .Time from induction  to active phase ,induction to delivery, outcomes of labor induction including improvement in BISHOP’s score, hyperstimulation, tachysystole, the cesarean section rates, & the neonatal outcomes including NICU admissions ,APGAR scores were recorded. Results: Maternal age, parity & gestational age ,and primary Bishops score were comparable in both the study groups. The time taken to progress to active phase was significantly shorter in Group A compared to Group B(7.4 versus 9.3).The mean induction to delivery time was also shorter with the combination of foley’s catheter & misoprostol(11 hours)when compared to misoprostol alone(13.7hours).In the present study it was noted that the rate of vaginal deliveries were significantly higher in combination method of induction. Cesarean section rates & fetal distress was found to be more in misoprostol group. There were no maternal or neonatal complications in both the study groups. Conclusion-Induction with Foley's catheter followed by misoprostol had a synergistic effect which resulted in shorter time to progress to active phase & lesser induction to delivery time with greater chances of vaginal delivery as compared to misoprostol alone.

Background: Cardiac sarcoidosis (CS) is an unusual, but potentially harmful, manifestation of systemic sarcoidosis (SA), a chronic disease characterized by organ involvement from noncaseating and non necrotizing granulomas. The cardiovascular involvement is usually associated with a bad prognosis and is responsible for the major cause of death and complications. Aim: The present study aims to evaluate clinical manifestation and diagnosis of Cardiac sarcoidosis Маterials and methods: This retrospective study was carried out in the department of medicine, cardiology and CTVS  in a tertiary care hospital, India. A total of 140 patients age ranged from 18 to 70 years, with a sarcoidosis diagnosis were screened, and 35 patients were diagnosed with CS based on JCS 2016 Guidelines. All medical records contain socio-demographic and clinical data was evaluated. Results: The majority of the patients 37.2% were 41-60 years age group, median age was 45.9 years. 60% was male, 54.3% residing at rural areas and 42.8% belonged to lower socio-economic class. Common clinical manifestations of CS were dyspnoea (71.4%), palpitation (48.6%), fatigue (34.3%), dizziness (31.4%) and chest pain in 25.7% of patients. Syncope (20%) and cardiac arrest (11.4%) were the common complication of CS Conclusion: As systemic sarcoidosis, CS remains a challenging issue in the matter of diagnostics. The evolution of clinical manifestation and diagnostic techniques in recent years has led to a significant improvement in the detection and classification of the severity of the disease.

Background: Maternal mortality is a measure of quality of health care in community. Maternal mortality ratio is a very sensitive index that reflect the quality of reproductive care provided to the pregnant women. The aims and objectives were to study the institutional maternal mortality, the causes of MMR.  Methods: A retrospective hospital-based study of 587 maternal death was done over a period of 4 years from Jan 2019 to Dec 2022 in obstetrics and gynaecology department, MGM Indore M.P. Details of all the mortalities were collected from individual case sheets, facility based maternal death review forms and MDR case summary. Results: A total of 587 deaths were analysed. MMR in the study period was 1455 per 1 lakh live births. Maximum maternal deaths were reported in the age group of 20-30 years. Majority of maternal death were reported in primipara (77.17%) as compared to multi(10.7%) and grand para (12.09%). Most of them were un-booked (52.8%) and belonged to rural areas (59.2%). In the present study, both direct and indirect causes contributed to more than 98% of maternal death and Non obstetrics cause were around 1.2% of maternal death. Common direct causes were hemorrhage (18.2%) (post-partum hemorrhage, ante-partum hemorrhage and abortion related hemorrhage), Hypertensive disorder of pregnancy ( eclampsia, severe preeclampsia hellp,CVA) contributed most i.e. (33.9%) Conclusions: Early identification of high-risk pregnancy, regular antenatal check-up and proper training of health personnel along with timely referral to tertiary care centre can help to reduce the mortality. There is an increase in MMR during the current pandemic 2020-2021.

Background: Covid-19 is a public health emergency of international concern.  It is prudent to identify patients with a high risk of acute respiratory distress syndrome by using systemic inflammatory biomarkers. Objectives: The study aims to evaluate serum biomarkers (C- reactive protein, Lactate dehydrogenase, Ferritin & D-dimer) for detecting covid19 severity and define cutoff of biomarkers for risk stratification of hospitalized patients. Methods: A retrospective observational study done at Mamata Academy of medical sciences, Hyderabad, during a period from June 2020 to December 2020. There were total of 212 cases (66 ICU & 146 Non ICU) of COVID19 diagnosed by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) by using nasopharyngeal swabs. Details on their demographics, diagnosis, and the values of biomarkers were obtained. Data was analyzed by Independent sample t-test, Receiver operating characteristics curve at maximum sensitivity & specificity and cutoff value using SPSS version 20.0. Results: The Mean age of ICU patient (65.06±13.47years) was higher than non ICU patient (44.66±11.97).The mean value of biomarkers in ICU patients such as CRP(40.79±27.40mg/lt), LDH(359.08±13.22U/lt), D-dimer(1545.27±1586.29µg/lt) and ferritin (538.41±441.70µg/lt) was higher than  non-ICU and difference is statistically significant (p <0.001). Receiver operating characteristics curve revealed that D- dimer (AUC = 0.87; 95% CI: 0.83–0.92) had the best predictive accuracy followed by CRP (AUC = 0.84; 95% CI: 0.78–0.90), LDH (AUC=0.75; 95% CI: 0.68-0.82) and ferritin (AUC = 0.68; 95% CI: 0.60–0.77). The cut off value for d-dimer & CRP in identifying ICU patient as compared to NON ICU is 357 µg/L & 16mg/L respectively. Conclusion: Inflammatory markers correlate well with COVID-19 severity and helps to devise best possible treatment protocols  for critical care patients to avoid preventable mortality. D-dimer followed by CRP, LDH & Serum ferritin accurately predict patients developing severe COVID-19 infections.

Introduction: Atrial Fibrillation is the most commonly encountered quivering or irregular heart beat (arrhythmia) in our population, and it is the disordered supraventricular (atria) event characterized by irregular heart rhythm, there by altered atrial electrical and mechanical function will occur, it will lead to significant economic burden to the society by causing morbidity and mortality. Aims: To find out the varied presenting symptoms of Atrial fibrillation, to find out possible underlying predisposing factors for Atrial fibrillation, both cardiac and non-cardiac in our population and to perform Transthoracic Echocardiography and analysis of its parameters in Atrial fibrillation patients. Materials and Methods: This study was a Cross-sectional study. This study was conducted in the Cardiology Department of NRS medical college, during the year January 2022 to December 2022. 100 patients were included in this study. Result: In the study group, 41.6% (N=32) of patients with RHD presented with failure, 39.1% (n=9) of patients with Non RHD presented with failure. The difference was statistically insignificant (‘P-value >.05). In our study 88% of the people had normal EF,6% of the people had mildly abnormal,4% of the people had moderately abnormal, and the remaining 2% of them presented with severely abnormal EF, Presence of abnormal EF(LV systolic dysfunction) independently predicts the risk of stroke shown by Atrial fibrillation investigators study. Conclusion: Patients with RHD etiology presented with AF in middle age, patients with Non RHD etiology presented in older age and patient presented with AF of rheumatic origin were mostly female patients, whereas non rheumatic origin were male patients.

Background: Mycobacterium wis an immunomodulatorthat evokes antigen-specific cell-mediated immunity and its use has been evaluated in patients with sepsis, where it resulted in improved outcome.  Methods: We collected data in ten adult patientswith suspected gram-negative sepsis admitted inthe intensive care unit. Injection Mw 0.3 ml was administered intradermal per day for three consecutive days alongwith continuation of standard care. Results: We observed clinical improvement and a significant decrease in TLC and SOFA Score on day 7 after Mw administration. Also, Mw was not associated with any local or systemic adverse effects. Conclusion: The use of Mw was safe and effective in patients with sepsis, though larger randomized trials are required to establish its role.

Background: Globally, prematurity affects 15 million newborns every year with numbers increasing in most countries according to the latest trend of data.1 Respiratory distress is one of the most common reasons because of which a neonate is admitted to the neonatal intensive care unit. Respiratory distress syndrome (RDS), earlier known as hyaline membrane disease, is one of the causes of respiratory distress in a preterm baby and is a known complication of prematurity.2 Aims & objective : To study the clinical outcome of respiratory distress syndrome in preterm neonates. Material & Methods: This prospective study was conducted in NICU on all preterm neonates meeting the inclusion and exclusion criteria, after taking informed written consent from parents/guardians of the neonates providing all the necessary information about the study. All enrolled preterm neonates were observed for development of any complication such as intracranial hemorrhage, pneumothorax, ventilator associated pneumonia, sepsis, retinopathy of prematurity, bronchopulmonary dysplasia Results : In this study , males were 44 (53.65%) and females were 38 (46.34%). Sepsis was the most common clinical outcome seen in 52  (63%) neonates, followed by retinopathy of prematurity in 8 (9.7%), intraventricular hemorrhage in 2(2.4%), ventilator associated pneumonia in 2(2.4%),  and suspected broncho-pulmonary dysplasia in 2(2.4%). Conclusion: Respiratory distress syndrome is significant cause of mortality and morbidity in preterm neonates in any country

Introduction: The central nervous system [CNS] is made up of the brain and the spinal cord. Cells within the CNS normally grow in an orderly and controlled way. If for some reason this disorder is disrupted the cells continue to divide and form a lump of tumour. CNS brain tumors is about equal in males and females – 51% for females and 49% for males (CBTRUS STUDY). The incidence of malignant CNS tumors is greater in males i.e. 7.2/1, 00,000. Brain tumor incidence tends to be higher in countries with more developed medical care. Aims: To evaluate the role of immunohistochemical markers in CNS tumours for confirmation and arriving at final diagnosis. Materials and Methods: In this prospective study of CNS neoplasms which covered 100 cases during January 2022 – January 2023, Darbhanga Medical College and Hospital, Bihar. The overall incidence of CNS neoplasms encountered by others was less than 9% (CBTRUS data) and in my observation it was 9.97%. Result: Of the 41 cases of the astrocytomas diagnosed there were 3 cases of grade I astrocytoma with an incidence of 7.3%. All the three cases, showed only an increase in cellularity. The three cases occurred in the middle age group with a slight increase in males (2:1). Conclusion: We conclude that, Primary CNS tumours are seen supratentorially in adults and in children it occurs infratentorially and Astrocytomas constitute the most common CNS tumor. Grading of astrocytomas by WHO norms reveal grade II pattern as the commonest.

Background: Uterine AV malformation is a rare cause of torrential post-abortal hemorrhage, which can present with varying grades of severity. Diagnosis requires a high degree of suspicion and is done with ultrasound and Doppler. Case Series conducted in IPGMER and SSKM Hospital, Kolkata, West Bengal, India during the period April 2020 to December 2022. Ten cases of symptomatic uterine AVMs have been reported. All of them were in the reproductive age group (22–35 years), presenting with a history of miscarriage or termination of pregnancy for which curettage was done. The presentation was with recurrent bouts of torrential bleeding, some triggered by second curettage, and not controllable with regular measures. Diagnosis was by ultrasound-gray scale, color Doppler, and spectral Doppler. On follow-up, all the ten patients are presently free of symptoms. Conclusion: Uterine AV malformation should be thought of as a differential diagnosis in all cases presenting with bleeding after miscarriage or curettage, since diagnosis is simple and treatment by selective arterial embolization saves morbidity of surgery and anesthesia, and more importantly reduces hospital stay and the absence from work.

Background: Magnesium has been known to have an influence in the causation of acute myocardial infarction (AMI) and plays a major role in the pathogenesis of other cardiovascular diseases. The present study was undertaken to evaluate the significance of serum magnesium in AMI and compare them with healthy adults and study its correlation with arrhythmias. Method: Total 62 cases and 62 controls were studied in the tertiary care hospital in centralIndiaover a period of around 2 years from December 2020 to December 2022. Results: The mean age of study subjects was 55.74±9.27years with male predominance (75.81%). Systematic hypertension (40.32%) and diabetes mellitus (32.26%)were the most common risk factors. All the patients presented with chest pain on admission. The anterior wall MI predominated in the study followed by inferior wall MI. The mean serum magnesium levels in cases were 1.98±0.33 and 2.26±0.18 in controls, (p<0.05). 14.5% of cases had hypomagnesemia. Serum magnesium in patients with Arrhythmias was 1.57±0.44 and patients without Arrhythmias was 1.99±0.32, (p<0.0049HS). Serum magnesium levels in patients who expired was 1.80±0.42 and in those who survived was 1.96±0.35 (p>0.05). Serum magnesium levels were correlated with development of complications like cardiogenic shock, congestive cardiac failure, complete heart block but it was reported not statistically significant association.Conclusion: Serum magnesium levels were found to be significantly lowin patients with AMIand in patients who develop arrhythmia. Serum magnesium levels were not found to be significantly lower in cases those who expired, therefore it did not have correlation with the mortality.

Background: Component separation technique typically involves one or more fascial planes incision to form myofascial advancement flaps to assist fascial closure in large ventral hernia repair. Aim of the study was to compare the outcomes and quality of life post operatively with traditional preperitoneal mesh repair. Methods: A prospective study was done on 40 patients in MKCG Medical College with ethical clearance. IEC no1087.It was a comparative study between component separation technique and traditional preperitoneal repair for large midline ventral hernia. Observations: Mean age of patients operated for CS were 49.5+SD10.15 and for Preperitoneal repair mean age was 48.95+SD9.87. Wound complications were 16% with mean follow up12 months and recurrence rate was 5% with odds ratio 0.21(0.021-2.079) p=0.91 when compared to preperitoneal mesh repair. Conclusion: The component separation technique was better regarding the shape of abdominal contour than pre peritoneal mesh repair. The use of component separation technique results in an increased risk of wound complications but does not increase the hernia recurrence rate CS with myofascial advancement flaps reduces chance of recurrence but does not impact on quality of life.

Background: In this study, we wanted to evaluate intrathecal hyperbaric bupivacaine with different doses of buprenorphine for infraumbilical surgeries on concurrent administration, with regard to the onset of sensory and motor blockade, the duration of motor blockade and effectiveness of post-operative analgesia. Materials And Methods: This was a hospital based prospective randomized clinical study conducted among 70 patients who underwent infraumbilical surgeries, in Kempegowda Institute of Medical Sciences and Research Centre, Bengaluru, over a period of 18 months from December 2019 to September 2021 after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants.  Results: The onset of sensory and motor blockade was comparable in both the groups. The duration of post-operative analgesia was longer in group 2 (60 mcg) when compared to group 1 (30 mcg) (p < 0.001). Side effects were noted with higher dose of 60 mcg than 30 mcg of buprenorphine.  Conclusion: The addition of buprenorphine 30 mcg and 60 mcg to intrathecal hyperbaric bupivacaine is safe as it does not produce excessive sedation or respiratory depression. Addition of 60 mcg buprenorphine to 0.5 % hyperbaric bupivacaine significantly prolongs the duration of post-operative analgesia better than 30 mcg buprenorphine (p value < 0.001) and the request for first analgesics without any significant motor blockade prolongation. Side effects like nausea and vomiting were noted to be seen significantly higher with dose 60 mcg than 30 mcg buprenorphine (p value 0.012). The patient’s well-being was satisfactory in both the groups.

Background: Most studies for the prediction of difficult airways have been done in Caucasians, and the cut-offs set by them may not be applicable to the Indian population. The purpose of the study was to compare the validity of the upper lip bite test and the modified Mallampati test in predicting difficult intubation in the Indian population. Methodology:  A total of 279 patients scheduled for elective surgical procedures requiring endotracheal intubation were enrolled, and the upper lip bite test (ULBT) and modified Mallampati test (MMT) were assessed preoperatively, and Cormack and Lehane’s grading was recorded while performing direct laryngoscopy. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and accuracy were calculated for the upper lip bite test, the modified Mallampati test, and for both tests in parallel. Results:  The percentage of patients with a difficult direct laryngoscopy was 12.9%. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and accuracy for the upper lip bite test were 80.56% ,98.35%, 48.94, 0.2,87.88% ,97.15 % and 96.06%; the corresponding values for the modified Mallampati test were 55.56% ,72.43% ,2.015 ,0.614, 22.98% ,96.67% and 70.25%; and the corresponding values when both tests are used in parallel are 94.44% ,71.19% ,3.28 ,0.08 ,32.69% ,98.86 % and 74.19%. Conclusion:  Based on the findings of the current study, the upper lip bite test was found to be superior to the modified Mallampati test in all aspects of diagnostic test evaluation and can be used as a good predictor of a difficult airway when the test is positive, although a negative test doesn't rule out difficult intubation. When both tests were used in parallel, the sensitivity goes up to 94% from 80% with ULBT used alone. This enables it to be used as a screening test for difficult intubation to predict most cases, but the low positive and negative likelihood ratios suggest the use is restricted in its efficient utility in many scenarios.

Purpose: The purpose of this study was to examine how the SARS-CoV-2 infection affects antenatal women and newborn babies in terms of symptoms, complications, and outcomes. Methods: A total of 128 antenatal women were included in this prospective single-center observational study. The present study was conducted in a tertiary-level public hospital in Kerala. The presence of SARS-CoV-2 was detected by running a real-time PCR using the extracted RNA using an appropriate PCR kit (SeegenAllplexTM 2019-nCoV Assay). Result: Out of 128 COVID-19-positive antenatal women, RT-PCR was positive for 57.8% of them, followed by antigen positive for 34.4% and TrueNat for 7.1%. The Mean ±SD duration of COVID positivity from delivery was 8.45±5.1 days and the Mean ±SD CRP was 3.15±6.2 mg/dl, Mean ±SD FERRITIN was 61.8±98.2 mg/l and the Mean ±SD D DIMER was 2.09±1.4 mg/l. Seven study subjects were transferred to the intensive care unit (ICU), 5 were given oxygen support, 3 were given NIV assistance with oxygen, and one was transferred on mechanical ventilation due to a severe complication. Out of 128 COVID-positive study subjects, the majority of them didn’t have any post-partum complications. 19 study subjects experienced complications such as PPH (10 study subjects), sepsis, and maternal near-miss (4 study subjects), and one study subject died due to thromboembolism. Conclusion: The study demonstrated that LSCS was more in COVID pregnant women. However, the majority of the COVID-positive pregnant women didn’t require ICU admission. Further, the study found that the majority of the neonates were COVID-negative and healthy.

Introduction: Drug therapy for Crohn’s disease and ulcerative colitis is based on anti‐inflammatory and immunomodulating drugs, nutritional support and surgical resection. 5-Aminosalicylates are extensively prescribed for the treatment of ulcerative colitis but have a wide range of described adverse effects. Aims: To record the probable adverse drug reactions of pharmacotherapeutics commonly prescribed in gastroenterology OPD and to assess the causality and severity of adverse events. Materials and Methods: This observational cross-sectional study was conducted Gastroenterology OPD, RG Kar Medical College, and Kolkata. Adult patients aged less than 65 completed years and participant must have a diagnosis of Ulcerative colitis / Crohn’s Disease were included in this study. Result: We examined that in without Smoker, 12 (15.2%) patients had Pedal oedema and in with Smoker, 1 (9.1%) patient had Pedal oedema which was not statistically significant (p=0.5898).In without Alcoholic, 11 (12.9%) patients had Pedal oedema and in with Alcoholic, 2 (40.0%) patients had Pedal oedema which was not statistically significant (p=0.0943). Conclusion: It was found that Psoriasis was significantly higher in non-diabetic patients compared to diabetic patients and Headache, Arthritis, Pain Abdomen were not significantly associated with diabetic patients but Skin rash was more in non- diabetic patients.

Introduction:  Introduction: Nerve Conduction Study (NCS) are most commonly used in neurophysiological laboratories not only for the understanding of normal peripheral nerve function and structure but also in relation to various diseases. Peripheral neuropathies are unfavorable consequences of radiation treatment. Tissue changes due to Radiation Exposure result in inflammation and fibrosis that affect the peripheral nerve and lead to peripheral neuropathies. Hence we have undertaken this study to observe effect of radiation exposure on peripheral nerve conduction study parameters in Radiologic Technologists of our institutions and compared the nerve conduction study with healthy individuals. Material and methods: Present study is a case control cross-sectional analytic prospective hospital-based study. In present study a sum of 60 individuals were selected, of which 30 were Radio-logic Technologists (study group/cases) who had a history of occupational exposure to ionizing radiations and 30 were age and sex matched normal healthy individuals (controls). Motor Nerve conduction study (MNCS) parameters for sensory and motor were recorded in Median, Ulnar and Radial nerves on both right and left Upper extremities and data was recorded.We found that the nerve conduction velocities of all the motor and sensory nerves were significantly reduced in radiologic technologists compared to healthy subjects.  Results and discussion :We also found reduced CMAP amplitude (significant in Ulnar, and Radial) and SNAP amplitude (significant in Median, Ulnar and Radial nerves) along with prolonged motor distal latencies (significant in Median, Ulnar and Tibial nerves) and sensory distal latencies (significant in Median, Ulnar and Radial nerves) among radiological technologists compared to healthy individuals. Conclusion: Present study depicting that ionizing radiations are harmful to all the body tissues including the peripheral nerves. Radiations appear to cause both demyelination and axonal loss.

Introduction: Fournier’s gangrene is an extensive necrotizing soft tissue infection of the perineum affecting the skin, soft tissues, and muscles. Early diagnosis remains imperative as rapid progression of the gangrene can lead to multiorgan failure and death. Treatment of Fournier’s gangrene entails treating sepsis, stabilizing medical parameters, and urgent surgical debridement. The present study was conducted to study the surgical outcome in operated cases of Fournier’s gangrene in the department of general surgery at a tertiary care centre. Methods: The present prospective clinical observational study was carried out on 62 patients with gangrene of the genitalia and perineum who came to the Department of general surgery in a tertiary care centre from October 2019 to October 2021. The diagnosis of Fournier’s gangrene was established clinically based on presenting history and physical examination and supported by investigations.  Results: 40.32% of patients were in the age group above 60 years. There was a male preponderance with 24.59% morbidity. Scrotal swelling was the most common presenting complaint in 60 patients (96.77%). 45.16% of patients presented within 7 days and had a morbidity of 28.57% with no mortality. 77.41% etiological factor of FG was idiopathic.  Diabetes Mellitus (27.41%), chronic alcoholism (22.58%), and smoking 17.74%), were the commonly observed comorbid condition. Testicular repositioning with secondary suturing was done in 65.38% of patients. Conclusion: Early stabilization of hemodynamic status and immediate debridement of whole necrotic tissues with appropriate antibiotic cover will certainly reduce the risk of morbidity. The presence of diabetes, advanced age, delayed presentation, and systemic sepsis on admission are individual risk factors described to predict mortality.

Introduction: Airway management in elective surgeries is best with endotracheal intubation. Both laryngoscopy and endotracheal intubation produce marked reflex sympathoadrenal stimulation which gives rise to hypertension and tachycardia. These reflex peaks within 1 min and ends in about 5–10 min after intubation which increases complications like myocardial ischemia left ventricular failure, and cerebral haemorrhage especially in patients with cardiovascular disease. Dexmedetomidine is a novel alpha-2 adrenergic agonist which decreases sympathoadrenal response and maintains haemodynamic stability during laryngoscopy and endotracheal intubation. Esmolol is a rapid onset, ultra-short acting, cardioselective beta-1 adrenergic receptor antagonist that possesses little sedative effect, but no analgesic activity and proved to be an effective agent to provide haemodynamic stability during laryngoscopy and endotracheal intubation. In the present study, we compared the effectiveness between Dexmedetomidine and Esmolol for attenuating haemodynamic response to laryngoscopy and endotracheal intubation during surgery under general anaesthesia. Methods: The present study was undertaken from November 2021 - June 2022, among 80 patients undergoing routine surgery under general anaesthesia randomly divided into 2 groups of 40 patients each by using a sealed envelope technique. Group D (Dexmedetomidine): consisting of 40 patients who received Dexmedetomidine 0.5μg/kg in 100ml normal saline, 3 minutes prior to intubation. Group E (Esmolol): consisting of 40 patients who received 1 mg/kg Esmolol, 3 minutes prior to intubation.  Results: There was a statistically significant lower HR, SBP, DBP and MAP in group D compared to group E during laryngoscopy and 1, 3, 5 and 7 minutes after endotracheal intubation. Conclusion: We can conclude that administration of a single dose of dexmedetomidine 0.5 μg/kg i.v. before laryngoscopy was an effective method for attenuating the hemodynamic response to endotracheal intubation compared to a single dose of esmolol 1 mg/kg i.v.

Background: Preoperative education is reported to be effective in improving postoperative outcomes and patients' satisfaction. Hence, this study was designed to estimate the impact of preoperative education programme on postoperative outcomes and patients' satisfaction in patients undergoing visceral organ surgery. Methods: A quasi-experimental study was designed wherein 100 patients who were admitted for elective visceral organ surgery were divided randomly in intervention (50) and control group (50). Intervention group received preoperative education based on patient centered communication by trained nurses. Patients’ satisfaction, postoperative complications and length of stay in hospital were measured. Results: Satisfaction scores were greater for intervention group. Post-operative complications and length of hospital stay were lesser for intervention group as compared to the comparison group. Conclusions: Preoperative education increases satisfaction of patients undergoing surgery and can reduce postoperative complications and ICU stays in surgical patients.

Introduction: Liver abscess are more prevalent due to pyogenic, amoebic or mixed infection. Sometimes these may be fungal in origin. The primary mode of treatment is medical, but 15% of these may be refractory to medical   treatment. Percutaneous drainage continues to be the basis of care in these situations. For the purpose of curing sepsis, liver abscesses greater than 5 cm in size must be promptly drained.  In contrast, surgical drainage enables the rupture of multiloculi and the draining of viscid pus from large abscesses that are multiloculated or contain thick viscid pus. Our aim is to assess the effectiveness, success rate, clinical improvement, time required for complete abscess resolution, and length of hospital stay for patients undergoing USG guided pigtail catheterization vs. open drainage in the management of liver abscess. Materials And Method: After obtaining approval from institutional ethical committee this prospective study was conducted in 32 patients with liver abscess who admitted in surgery department of M.K.CG. MCH, Berhampur. On the basis of the clinical history, serologic testing (IgM Elisa), and inspection, followed by USG, a liver abscess was diagnosed. Standard investigations were conducted.. The patients included in the study were having non complicated abscesses with no features of rupture, no feature of impending rupture (liver tissue rim >1cm), no compression effect and abscess size >5 cm diameter. Patients who had multiple abscess cavities, ruptured or threatened abscesses, peritonitis symptoms and signs, and abscesses larger than 5 cm in diameter were excluded from the study.  Results: Mean age in group PD was 36yr while in group SD it was 35.9yr. There is male predominance in both the groups. A commonest symptom in both the groups was abdominal pain. Next common symptom was fever which was present in all patients of group PD and 13 patients in group SD. In both the groups (table 1) Haemoglobin and Liver function test was in normal range. Leucocytosis was present in 85% of cases and raised ESR in 90% of cases in both the groups. Volume of abscess ranged from 114 to 1200 ml 9. In group PD, success rate was 94.4 % while in group SD success rate was 100%. Total clinical improvement was seen in 4-8 days and 4-7days in Group PD and Group SD respectively. Time needed for total reduction was 5- 17 weeks in Group PD and 7-24 weeks in group SD. Hospital stay was 5-18 days and 6-21 days in group PD and SD respectively. Morbidity is 27% in group PD and 50% in group SD. Conclusion The conventional treatment for liver abscess is percutaneous catheter drainage (PCD), which is both safe and efficient. It leads to early symptom alleviation and quicker abscess cavity clearance. Surgery is an option for liver abscess drainage with concurrent intraabdominal pathology, multiloculated abscess with biliary communication, and failure of percutaneous drainage. PCD also has low morbidity and a good success rate, allowing it to be used as first line management in liquefied moderate sized abscesses.

Background: In this study we wanted to evaluate the maternal morbidity in women with moderate and severe anaemia and compare maternal and perinatal outcome in moderate and severe anaemic pregnant females with those of non-anaemic pregnant females delivering at or more than 28 weeks of gestation. Methods This was a hospital based prospective case control study conducted among 75 pregnant women who presented with severe anemia to the Department of Obstetrics and Gynecology, Christian Medical College and Hospital, Ludhiana, over a period of 18 months, from November 2020 to May 2022 after obtaining clearance from institutional ethics committee and written informed consent from the study participants.  Results In distribution according to antenatal complications, past medical history, history of blood transfusion, anthropometric parameters, hemogram, mode of delivery, approximate intrapartum blood loss (mL), admission of neonates to NICU, in cases and controls were found to be statistically significant. Requirement of blood transfusion was significantly higher in cases as compared to controls. P value- <.0001 and was statistically significant. Postpartum complications were significantly higher in cases as compared to controls, with p value <.0001, which was statistically significant. Birth weight was significantly lower in cases as compared to controls and was statistically significant. APGAR score at 1 minute was significantly lower in cases as compared to controls. Conclusion Awareness and education on early antenatal bookings, regular iron intake and continuous antenatal care should be the goal in tackling anemia in pregnancy.

Aim: To study rhino–orbital–cerebral mucormycosis related to COVID-19 infection. Material and Methods: This is a cross sectional study done at the tertiary health care centre at Gandhi Medical College, Secunderabad and Sarojini Devi Eye Hospital, Hyderabad, Telangana between  1-4-2021 to 21-6-2021 and the study subjects were post covid-19 patients with fungal invasion. The patients were evaluated and managed for associated ENT, Neuro and Dental and Ophthalmic comorbidities and systemic diseases like diabetes mellitus. A thorough descriptive and analytical study was done and presented as numbers and calculated percentages. Results: 50-59 years age group is predominate with Gender Ratio: male (120): female (62)it is 1:2.Over 182 cases of post covid -19 with suspected fungal invasion were studied and found that 135 (74%) patients with diabetes and 44 (24%)patients were denovo detected to have Diabetes mellitus ie total 179 (98.3%) patients are with diabetes . 156 (85.8%) have taken corticosteroids. Conclusion: As per the evaluation during the management of post covid-19 there seems to be direct correlation between hyperglycemic state of Diabetes mellitus, use of cortico steroids, leading to proptosis, panophthalmitis and loss of vision. Therefore meticulous use of cortico steroids, and thorough evaluation and management of Diabetes mellitus state would decrease the morbidity and mortality of the patient

Introduction:  One of the leading causes of cancer death in the less developed countries of the world is breast cancer. This is partly because of clinical advances to combat the disease which are not reaching the women living in those regions and also because of a shift in lifestyle, which is causing an increase in its incidence. All detected breast lesions are not malignant and all the benign masses do not progress to cancer; never-theless the precision of the final diagnosis can be greatly increased by radiological imaging (mammography, ultrasonography) and pathological diagnosis. Aims: To study the mammographic and ultrasonographic characteristics of breast lesions in patients, categorize the detected breast lesions according to BI-RADS, to correlate the categorized breast lesions (BI-RADS) with FNAC and compare the sensitivity of mammography with ultrasonography in diagnosing benign and malignant breast lesions. Materials and methos: This is a cross-sectional study completed during a period of one year in the DEPARTMENT OF RADIOLOGY,  KPC MEDICAL COLLEGE AND HOSPITAL, JADAVPUR. KOLKATA. Total 50 patients were included in this study. Result: All fat containing and low density lesions on mammography were benign on FNAC and the lesions which were of high density turned out to be either benign or malignant. Out of the total 16 FNAC proven malignant cases, the most common site was the central (retroareolar) region (5 cases). Commonest site was upper outer quadrant for benign lesions. All the oval lesions on mammography were benign except for one. Out of the 18 round lesions, 15 were found to be malignant. All lesions with spiculated margins and with fine pleomorphic type of calcification in mammography were found to be positive for malignancy in both mammography and on FNAC. All the oval shaped lesions on USG were proved to be benign on FNAC. All spiculated margin lesions in ultrasonography were found to be positive for malignancy on FNAC, while all the well circumscribed lesions were found to be benign. Conclusion: Combined USG and mammography yielded the best result and can be used as a screening modality to detect malignancy earlier and to treat the patient earlier.

Introduction: Plantar heel pain (PHP), which affects 4%–7.0% of the community, is associated with impaired health-related quality of life including social isolation, a poor perception of health status and reduced functional capabilities. Aims: To develop a best practice guide for managing people with plantar heel pain (PHP). Materials and methods: The Present Study was a Observational study. This study was conducted from March 2021 to 2023 at department orthopaedic OPD of R G Kar Medical College and Hospital with plantar heel pain. Total 100 Patients were included in this Study. Result: There was good expert agreement with systematic review findings recommending stepped care management with focused shockwave for first step pain in the short-term (OR: 1.89, 95% CI 1.18 to 3.04), medium-term (SMD 1.31, 95% CI 0.61 to 2.01) and long-term (SMD 1.67, 95% CI 0.88 to 2.45) and radial shockwave for first step pain in the short term (OR: 1.66, 95% CI 1.00 to 2.76) and long term (OR: 1.78, 95% CI 1.07 to 2.96). We found good agreement to ‘step care’ using custom foot orthoses for general pain in the short term (SMD: 0.41, 95% CI 0.07 to 0.74) and medium term (SMD: 0.55, 95% CI 0.09 to 1.02). Conclusion: Best practice from a mixed-methods study synthesising systematic review with expert opinion and patient feedback suggests core treatment for people with PHP should include taping, stretching and individualised education. Patients who do not optimally improve may be offered shockwave therapy, followed by custom orthoses.